- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,168.69 / $9,772.37
| Facility | | $1,819.70 | $4,168.69 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,288.25 / $3,235.94
| Professional | | $1,047.13 | $1,288.25 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $15,488.17 / $24,547.09
| Facility | | $5,623.41 | $15,488.17 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,398.83 / $3,388.44
| Professional | | $1,096.48 | $2,398.83 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $2,041.74 / $3,981.07
| Professional | | $467.74 | $2,041.74 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $7,943.28
| Facility | | $7,943.28 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,995.26 / $3,388.44
| Professional | | $1,230.27 | $1,995.26 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $7,943.28
| Facility | | $7,943.28 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,949.84 / $3,467.37
| Professional | | $1,258.93 | $1,949.84 | $3,467.37 |