- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $4,570.88 / $11,220.18
| Facility | | $1,318.26 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,380.38 / $2,754.23
| Professional | | $1,122.02 | $1,380.38 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $8,709.64 / $16,595.87
| Facility | | $3,467.37 | $8,709.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,584.89 / $2,951.21
| Professional | | $1,047.13 | $1,584.89 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,951.21 / $8,317.64
| Facility | | $398.11 | $2,951.21 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,819.70 / $3,981.07
| Professional | | $1,148.15 | $1,819.70 | $3,981.07 |
- 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
- $1,047.13 / $1,513.56 / $2,818.38
| Professional | | $1,047.13 | $1,513.56 | $2,818.38 |