- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $7,079.46 / $11,481.54
| Facility | | $4,168.69 | $7,079.46 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,548.82 / $2,398.83
| Professional | | $1,174.90 | $1,548.82 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $7,413.10 / $20,892.96
| Facility | | $2,187.76 | $7,413.10 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,818.38 / $3,311.31
| Professional | | $1,905.46 | $2,818.38 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $776.25
| Facility | | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $9,772.37 / $9,772.37
| Professional | | $9,772.37 | $9,772.37 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,511.89 / $8,912.51
| Professional | | $1,819.70 | $2,511.89 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $13,803.84 / $39,810.72
| Facility | | $3,235.94 | $13,803.84 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,398.83 / $3,548.13
| Professional | | $1,778.28 | $2,398.83 | $3,548.13 |