- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $4,570.88 / $12,022.64
| Facility | | $1,288.25 | $4,570.88 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,318.26 / $2,818.38
| Professional | | $1,096.48 | $1,318.26 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $10,715.19 / $20,892.96
| Facility | | $3,801.89 | $10,715.19 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,548.82 / $2,818.38
| Professional | | $1,047.13 | $1,548.82 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,951.21 / $8,128.31
| Facility | | $398.11 | $2,951.21 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,778.28 / $3,801.89
| Professional | | $1,096.48 | $1,778.28 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,888.44 / $12,022.64
| Facility | | $1,905.46 | $5,888.44 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,445.44 / $2,691.53
| Professional | | $1,023.29 | $1,445.44 | $2,691.53 |