- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,570.88 / $11,220.18
| Facility | | $1,380.38 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,412.54 / $2,818.38
| Professional | | $1,174.90 | $1,412.54 | $2,818.38 |
- 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
- $1,122.02 / $1,737.80 / $3,311.31
| Professional | | $1,122.02 | $1,737.80 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,162.28 / $9,332.54
| Facility | | $398.11 | $3,162.28 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,995.26 / $3,890.45
| Professional | | $1,230.27 | $1,995.26 | $3,890.45 |
- 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
- $1,122.02 / $1,659.59 / $2,951.21
| Professional | | $1,122.02 | $1,659.59 | $2,951.21 |