- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,466.84 / $10,964.78
| Facility | | $1,348.96 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,380.38 / $2,691.53
| Professional | | $1,148.15 | $1,380.38 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $8,511.38 / $20,417.38
| Facility | | $3,388.44 | $8,511.38 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,380.38 / $3,090.30
| Professional | | $851.14 | $1,380.38 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $3,981.07 / $9,549.93
| Facility | | $512.86 | $3,981.07 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,819.70 / $4,073.80
| Professional | | $954.99 | $1,819.70 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,244.36 / $16,982.44
| Facility | | $2,454.71 | $7,244.36 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,412.54 / $2,884.03
| Professional | | $831.76 | $1,412.54 | $2,884.03 |