- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,897.79 / $11,748.98
| Facility | | $1,513.56 | $4,897.79 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,318.26 / $2,951.21
| Professional | | $1,148.15 | $1,318.26 | $2,951.21 |
- 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
- $1,148.15 / $1,659.59 / $3,090.30
| Professional | | $1,148.15 | $1,659.59 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,388.44 / $8,912.51
| Facility | | $323.59 | $3,388.44 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,862.09 / $3,890.45
| Professional | | $1,230.27 | $1,862.09 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,754.40 / $14,454.40
| Facility | | $1,862.09 | $5,754.40 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,513.56 / $2,754.23
| Professional | | $1,071.52 | $1,513.56 | $2,754.23 |