- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,897.79 / $11,481.54
| Facility | | $1,621.81 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,398.83 / $3,715.35
| Professional | | $1,318.26 | $2,398.83 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,370.32 / $14,454.40
| Facility | | $3,311.31 | $5,370.32 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,380.38 / $5,623.41
| Professional | | $512.86 | $1,380.38 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $2,884.03 / $10,964.78
| Facility | | $371.54 | $2,884.03 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $3,235.94 / $7,585.78
| Professional | | $954.99 | $3,235.94 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,818.38 / $9,549.93
| Facility | | $537.03 | $2,818.38 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,511.89 / $4,786.30
| Professional | | $1,621.81 | $2,511.89 | $4,786.30 |