- 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
- $1,174.90 / $1,412.54 / $3,162.28
| Professional | | $1,174.90 | $1,412.54 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $9,332.54 / $17,378.01
| Facility | | $3,630.78 | $9,332.54 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,659.59 / $3,090.30
| Professional | | $1,122.02 | $1,659.59 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,162.28 / $8,912.51
| Facility | | $398.11 | $3,162.28 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,905.46 / $4,168.69
| Professional | | $1,202.26 | $1,905.46 | $4,168.69 |
- 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
- $1,096.48 / $1,548.82 / $2,884.03
| Professional | | $1,096.48 | $1,548.82 | $2,884.03 |