- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,570.88 / $10,964.78
| Facility | | $1,348.96 | $4,570.88 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,380.38 / $2,951.21
| Professional | | $1,096.48 | $1,380.38 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $11,220.18 / $22,908.68
| Facility | | $4,073.80 | $11,220.18 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,621.81 / $3,019.95
| Professional | | $1,071.52 | $1,621.81 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,467.37 / $9,772.37
| Facility | | $323.59 | $3,467.37 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,862.09 / $3,890.45
| Professional | | $1,174.90 | $1,862.09 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,513.56 / $2,818.38
| Professional | | $1,047.13 | $1,513.56 | $2,818.38 |