- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,570.88 / $11,220.18
| Facility | | $1,445.44 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,548.82 / $3,162.28
| Professional | | $1,258.93 | $1,548.82 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $9,332.54 / $17,782.79
| Facility | | $3,630.78 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,778.28 / $3,467.37
| Professional | | $1,148.15 | $1,778.28 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,388.44 / $8,511.38
| Facility | | $398.11 | $3,388.44 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,137.96 / $4,265.80
| Professional | | $1,348.96 | $2,137.96 | $4,265.80 |
- 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
- $1,230.27 / $1,778.28 / $3,162.28
| Professional | | $1,230.27 | $1,778.28 | $3,162.28 |