- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,677.35 / $11,481.54
| Facility | | $1,778.28 | $4,677.35 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,995.26 / $3,981.07
| Professional | | $1,584.89 | $1,995.26 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $10,715.19 / $20,892.96
| Facility | | $3,890.45 | $10,715.19 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,344.23 / $4,365.16
| Professional | | $1,621.81 | $2,344.23 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $4,466.84 / $12,589.25
| Facility | | $398.11 | $4,466.84 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,691.53 / $5,888.44
| Professional | | $1,698.24 | $2,691.53 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,187.76 / $4,073.80
| Professional | | $1,548.82 | $2,187.76 | $4,073.80 |