- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $7,585.78 / $11,748.98
| Facility | | $4,466.84 | $7,585.78 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,737.80 / $6,456.54
| Professional | | $1,479.11 | $1,737.80 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,344.23 / $5,370.32
| Professional | | $1,548.82 | $2,344.23 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,862.09 / $2,570.40
| Professional | | $1,513.56 | $1,862.09 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $16,595.87 / $30,902.95
| Facility | | $11,748.98 | $16,595.87 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,137.96 / $6,918.31
| Professional | | $1,380.38 | $2,137.96 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $8,709.64 / $21,379.62
| Facility | | $3,890.45 | $8,709.64 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,698.24 / $4,168.69
| Professional | | $1,258.93 | $1,698.24 | $4,168.69 |