- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,897.79 / $8,511.38
| Facility | | $1,778.28 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,096.48 / $2,454.71
| Professional | | $371.54 | $1,096.48 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,479.11 / $3,467.37
| Facility | | $1,202.26 | $1,479.11 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,623.41 / $8,912.51
| Professional | | $1,148.15 | $5,623.41 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,096.48
| Professional | | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $5,888.44 / $5,888.44
| Professional | | $5,888.44 | $5,888.44 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,511.89 / $9,772.37
| Facility | | $758.58 | $2,511.89 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $8,128.31 / $13,182.57
| Professional | | $1,047.13 | $8,128.31 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,818.38 / $10,471.29
| Facility | | $1,174.90 | $2,818.38 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $6,309.57 / $12,882.50
| Professional | | $1,148.15 | $6,309.57 | $12,882.50 |