- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,495.41 / $11,748.98
| Facility | | $2,570.40 | $5,495.41 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,659.59 / $3,715.35
| Professional | | $1,380.38 | $1,659.59 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $6,456.54 / $10,964.78
| Facility | | $3,467.37 | $6,456.54 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,187.76 / $2,951.21
| Professional | | $1,698.24 | $2,187.76 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,290.87 / $3,090.30
| Professional | | $1,698.24 | $2,290.87 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $6,918.31
| Professional | | $1,862.09 | $1,862.09 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,548.82
| Professional | | $1,318.26 | $1,318.26 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $12,022.64 / $20,417.38
| Facility | | $8,511.38 | $12,022.64 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,238.72 / $3,715.35
| Professional | | $1,737.80 | $2,238.72 | $3,715.35 |