- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,570.88 / $11,220.18
| Facility | | $1,348.96 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,348.96 / $2,754.23
| Professional | | $1,148.15 | $1,348.96 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $10,471.29 / $19,952.62
| Facility | | $3,890.45 | $10,471.29 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,621.81 / $3,090.30
| Professional | | $1,174.90 | $1,621.81 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,715.35 / $10,471.29
| Facility | | $323.59 | $3,715.35 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,905.46 / $4,073.80
| Professional | | $1,174.90 | $1,905.46 | $4,073.80 |
- 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
- $1,071.52 / $1,548.82 / $2,884.03
| Professional | | $1,071.52 | $1,548.82 | $2,884.03 |