- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $5,248.07 / $12,302.69
| Facility | | $1,548.82 | $5,248.07 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,548.82 / $3,090.30
| Professional | | $1,288.25 | $1,548.82 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $8,511.38 / $16,218.10
| Facility | | $3,235.94 | $8,511.38 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,621.81 / $3,467.37
| Professional | | $1,023.29 | $1,621.81 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,570.40 / $10,715.19
| Facility | | $398.11 | $2,570.40 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,089.30 / $4,570.88
| Professional | | $1,148.15 | $2,089.30 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $8,709.64 / $19,054.61
| Facility | | $2,884.03 | $8,709.64 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,584.89 / $3,235.94
| Professional | | $977.24 | $1,584.89 | $3,235.94 |