- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $4,570.88 / $11,220.18
| Facility | | $1,318.26 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,380.38 / $3,090.30
| Professional | | $1,096.48 | $1,380.38 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $12,589.25 / $24,547.09
| Facility | | $4,265.80 | $12,589.25 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,698.24 / $3,162.28
| Professional | | $1,071.52 | $1,698.24 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,090.30 / $9,120.11
| Facility | | $398.11 | $3,090.30 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,905.46 / $3,801.89
| Professional | | $1,174.90 | $1,905.46 | $3,801.89 |
- 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
- $1,071.52 / $1,548.82 / $2,818.38
| Professional | | $1,071.52 | $1,548.82 | $2,818.38 |