- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $4,570.88 / $11,481.54
| Facility | | $1,318.26 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,348.96 / $2,691.53
| Professional | | $1,096.48 | $1,348.96 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $10,964.78 / $22,387.21
| Facility | | $4,073.80 | $10,964.78 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,659.59 / $3,090.30
| Professional | | $1,071.52 | $1,659.59 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,884.03 / $8,912.51
| Facility | | $398.11 | $2,884.03 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,905.46 / $3,715.35
| Professional | | $1,174.90 | $1,905.46 | $3,715.35 |
- 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 |