- 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 / $1,288.25 / $2,951.21
| Professional | | $1,096.48 | $1,288.25 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $12,302.69 / $26,915.35
| Facility | | $4,677.35 | $12,302.69 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,819.70 / $3,162.28
| Professional | | $1,174.90 | $1,819.70 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,715.35 / $10,964.78
| Facility | | $398.11 | $3,715.35 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,862.09 / $3,981.07
| Professional | | $1,202.26 | $1,862.09 | $3,981.07 |
- 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
- $1,047.13 / $1,479.11 / $2,754.23
| Professional | | $1,047.13 | $1,479.11 | $2,754.23 |