- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $4,570.88 / $11,220.18
| Facility | | $1,288.25 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,318.26 / $2,818.38
| Professional | | $1,122.02 | $1,318.26 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $10,715.19 / $20,417.38
| Facility | | $3,981.07 | $10,715.19 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,737.80 / $3,162.28
| Professional | | $1,148.15 | $1,737.80 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,235.94 / $9,332.54
| Facility | | $398.11 | $3,235.94 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,949.84 / $4,168.69
| Professional | | $1,202.26 | $1,949.84 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $10,232.93 / $23,988.33
| Facility | | $3,715.35 | $10,232.93 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,584.89 / $2,884.03
| Professional | | $1,096.48 | $1,584.89 | $2,884.03 |