- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,570.88 / $11,220.18
| Facility | | $1,348.96 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,380.38 / $2,818.38
| Professional | | $1,122.02 | $1,380.38 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $11,748.98 / $27,542.29
| Facility | | $4,265.80 | $11,748.98 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,659.59 / $3,162.28
| Professional | | $1,096.48 | $1,659.59 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,388.44 / $9,332.54
| Facility | | $323.59 | $3,388.44 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,905.46 / $3,890.45
| Professional | | $1,174.90 | $1,905.46 | $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
- $1,096.48 / $1,548.82 / $2,818.38
| Professional | | $1,096.48 | $1,548.82 | $2,818.38 |