- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,513.56 / $3,890.45
| Facility | | $501.19 | $1,513.56 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,479.11 / $2,290.87
| Professional | | $1,148.15 | $1,479.11 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,511.38 / $12,589.25
| Facility | | $5,011.87 | $8,511.38 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,737.80 / $2,187.76
| Professional | | $1,380.38 | $1,737.80 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $1,148.15
| Facility | | $39.81 | $39.81 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $426.58
| Facility | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,698.24 / $2,344.23
| Professional | | $1,023.29 | $1,698.24 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,248.07 / $13,182.57
| Facility | | $1,148.15 | $5,248.07 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,412.54 / $2,754.23
| Professional | | $1,096.48 | $1,412.54 | $2,754.23 |