- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,570.88 / $11,481.54
| Facility | | $1,621.81 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,862.09 / $4,365.16
| Professional | | $1,584.89 | $1,862.09 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $8,511.38 / $16,982.44
| Facility | | $2,818.38 | $8,511.38 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,290.87 / $4,466.84
| Professional | | $1,479.11 | $2,290.87 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,630.78 / $12,022.64
| Facility | | $1,412.54 | $3,630.78 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,754.23 / $5,888.44
| Professional | | $1,659.59 | $2,754.23 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,079.46 / $15,488.17
| Facility | | $2,454.71 | $7,079.46 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,187.76 / $4,168.69
| Professional | | $1,513.56 | $2,187.76 | $4,168.69 |