- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,677.35 / $11,481.54
| Facility | | $1,548.82 | $4,677.35 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,737.80 / $3,801.89
| Professional | | $1,412.54 | $1,737.80 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $12,022.64 / $26,915.35
| Facility | | $4,466.84 | $12,022.64 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,041.74 / $3,981.07
| Professional | | $1,380.38 | $2,041.74 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $4,073.80 / $11,481.54
| Facility | | $398.11 | $4,073.80 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,454.71 / $5,495.41
| Professional | | $1,445.44 | $2,454.71 | $5,495.41 |
- 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
- $1,348.96 / $1,995.26 / $3,890.45
| Professional | | $1,348.96 | $1,995.26 | $3,890.45 |