- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,570.88 / $11,220.18
| Facility | | $1,548.82 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,698.24 / $3,388.44
| Professional | | $1,348.96 | $1,698.24 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $12,022.64 / $23,988.33
| Facility | | $4,073.80 | $12,022.64 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,949.84 / $3,801.89
| Professional | | $1,318.26 | $1,949.84 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,630.78 / $9,549.93
| Facility | | $398.11 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,290.87 / $4,786.30
| Professional | | $1,445.44 | $2,290.87 | $4,786.30 |
- 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
- $1,288.25 / $1,862.09 / $3,467.37
| Professional | | $1,288.25 | $1,862.09 | $3,467.37 |