- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $4,570.88 / $11,220.18
| Facility | | $1,288.25 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,318.26 / $2,630.27
| Professional | | $1,096.48 | $1,318.26 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $9,772.37 / $17,782.79
| Facility | | $3,890.45 | $9,772.37 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,548.82 / $3,019.95
| Professional | | $1,023.29 | $1,548.82 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,162.28 / $8,709.64
| Facility | | $323.59 | $3,162.28 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,905.46 / $3,630.78
| Professional | | $1,148.15 | $1,905.46 | $3,630.78 |
- 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
- $1,047.13 / $1,548.82 / $2,754.23
| Professional | | $1,047.13 | $1,548.82 | $2,754.23 |