- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $4,570.88 / $11,481.54
| Facility | | $1,288.25 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,288.25 / $2,454.71
| Professional | | $1,071.52 | $1,288.25 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $9,332.54 / $17,378.01
| Facility | | $3,467.37 | $9,332.54 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,318.26 / $2,570.40
| Professional | | $1,023.29 | $1,318.26 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,041.74 / $5,128.61
| Facility | | $398.11 | $2,041.74 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,584.89 / $3,311.31
| Professional | | $1,000.00 | $1,584.89 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,818.38 / $9,772.37
| Facility | | $537.03 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,380.38 / $2,511.89
| Professional | | $977.24 | $1,380.38 | $2,511.89 |