- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $9,120.11 / $12,022.64
| Facility | | $1,698.24 | $9,120.11 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,698.24 / $2,398.83
| Professional | | $1,023.29 | $1,698.24 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,659.59 / $5,248.07
| Facility | | $1,621.81 | $1,659.59 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $2,290.87
| Professional | | $2,290.87 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $44.67 / $79.43
| Professional | | $44.67 | $44.67 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,290.87 / $8,912.51
| Facility | | $1,621.81 | $2,290.87 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,698.24 / $1,905.46
| Professional | | $1,621.81 | $1,698.24 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $5,495.41
| Professional | | $1,318.26 | $1,318.26 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,659.59 / $2,818.38
| Professional | | $1,513.56 | $1,659.59 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $1,148.15
| Professional | | $794.33 | $794.33 | $1,148.15 |