- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,466.84 / $10,964.78
| Facility | | $1,445.44 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,584.89 / $3,548.13
| Professional | | $1,258.93 | $1,584.89 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $7,585.78 / $16,218.10
| Facility | | $2,884.03 | $7,585.78 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,862.09 / $3,630.78
| Professional | | $1,288.25 | $1,862.09 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,630.27 / $10,232.93
| Facility | | $1,122.02 | $2,630.27 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,089.30 / $4,677.35
| Professional | | $1,380.38 | $2,089.30 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,370.32 / $12,022.64
| Facility | | $1,621.81 | $5,370.32 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,737.80 / $3,311.31
| Professional | | $1,174.90 | $1,737.80 | $3,311.31 |