- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,235.94 / $8,128.31
| Facility | | $1,479.11 | $3,235.94 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,445.44 / $1,778.28
| Professional | | $1,148.15 | $1,445.44 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,311.31 / $8,912.51
| Facility | | $1,148.15 | $3,311.31 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $426.58 / $2,089.30
| Professional | | $338.84 | $426.58 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,715.35 / $8,128.31
| Facility | | $1,258.93 | $3,715.35 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,818.38 / $5,370.32
| Professional | | $2,238.72 | $2,818.38 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,949.84 / $2,344.23
| Facility | | $1,047.13 | $1,949.84 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,047.13 / $2,137.96
| Professional | | $741.31 | $1,047.13 | $2,137.96 |