- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $5,248.07 / $10,232.93
| Facility | | $1,318.26 | $5,248.07 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,479.11 / $1,819.70
| Professional | | $1,148.15 | $1,479.11 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,445.44 / $7,762.47
| Facility | | $977.24 | $1,445.44 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,754.23 / $9,120.11
| Professional | | $2,290.87 | $2,754.23 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,621.81
| Professional | | $1,148.15 | $1,148.15 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,548.82 / $1,698.24
| Professional | | $1,148.15 | $1,548.82 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,698.24 / $1,905.46
| Facility | | $794.33 | $1,698.24 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $794.33 / $2,818.38
| Professional | | $660.69 | $794.33 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,148.15 / $1,148.15
| Professional | | $512.86 | $1,148.15 | $1,148.15 |