- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,570.88 / $11,748.98
| Facility | | $1,202.26 | $4,570.88 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,230.27 / $3,019.95
| Professional | | $1,023.29 | $1,230.27 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $12,302.69 / $26,915.35
| Facility | | $4,570.88 | $12,302.69 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,659.59 / $3,019.95
| Professional | | $1,071.52 | $1,659.59 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,467.37 / $10,964.78
| Facility | | $398.11 | $3,467.37 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,698.24 / $3,715.35
| Professional | | $1,122.02 | $1,698.24 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,232.93 / $23,988.33
| Facility | | $3,630.78 | $10,232.93 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,380.38 / $2,570.40
| Professional | | $954.99 | $1,380.38 | $2,570.40 |