- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,754.40 / $14,125.38
| Facility | | $1,659.59 | $5,754.40 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,548.82 / $3,467.37
| Professional | | $1,348.96 | $1,548.82 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,912.51 / $19,054.61
| Facility | | $2,951.21 | $8,912.51 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,995.26 / $3,715.35
| Professional | | $1,348.96 | $1,995.26 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,168.69 / $10,964.78
| Facility | | $1,778.28 | $4,168.69 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,290.87 / $4,897.79
| Professional | | $1,412.54 | $2,290.87 | $4,897.79 |
- 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
- $1,258.93 / $1,862.09 / $3,388.44
| Professional | | $1,258.93 | $1,862.09 | $3,388.44 |