- 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
- $1,148.15 / $1,412.54 / $2,951.21
| Professional | | $1,148.15 | $1,412.54 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $12,882.50 / $24,547.09
| Facility | | $4,265.80 | $12,882.50 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,737.80 / $3,311.31
| Professional | | $1,096.48 | $1,737.80 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,162.28 / $9,549.93
| Facility | | $398.11 | $3,162.28 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,949.84 / $3,981.07
| Professional | | $1,202.26 | $1,949.84 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $13,489.63 / $28,840.32
| Facility | | $3,981.07 | $13,489.63 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,584.89 / $2,884.03
| Professional | | $1,096.48 | $1,584.89 | $2,884.03 |