- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,897.79 / $11,220.18
| Facility | | $1,380.38 | $4,897.79 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,659.59 / $3,548.13
| Professional | | $1,513.56 | $1,659.59 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $30,199.52 / $43,651.58
| Facility | | $11,481.54 | $30,199.52 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,089.30 / $3,388.44
| Professional | | $1,548.82 | $2,089.30 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,659.59 / $1,862.09
| Facility | | $1,513.56 | $1,659.59 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $5,623.41
| Facility | | $4,677.35 | $4,677.35 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,041.74 / $3,388.44
| Professional | | $1,584.89 | $2,041.74 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $11,220.18 / $17,378.01
| Facility | | $5,011.87 | $11,220.18 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,819.70 / $3,162.28
| Professional | | $1,348.96 | $1,819.70 | $3,162.28 |