- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,570.88 / $11,481.54
| Facility | | $1,258.93 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,258.93 / $2,754.23
| Professional | | $1,096.48 | $1,258.93 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $10,964.78 / $21,877.62
| Facility | | $3,981.07 | $10,964.78 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,659.59 / $3,019.95
| Professional | | $1,122.02 | $1,659.59 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,090.30 / $8,709.64
| Facility | | $398.11 | $3,090.30 | $8,709.64 |
- 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 / $1,513.56 / $2,818.38
| Professional | | $1,071.52 | $1,513.56 | $2,818.38 |