- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,890.45 / $9,772.37
| Facility | | $1,445.44 | $3,890.45 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,905.46 / $2,818.38
| Professional | | $1,513.56 | $1,905.46 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $1,479.11
| Professional | | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $13,803.84 / $22,387.21
| Facility | | $8,912.51 | $13,803.84 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,089.30 / $2,290.87
| Professional | | $1,698.24 | $2,089.30 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,949.84 / $2,454.71
| Professional | | $1,584.89 | $1,949.84 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,073.80 / $10,964.78
| Facility | | $1,621.81 | $4,073.80 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,995.26 / $12,882.50
| Professional | | $1,479.11 | $1,995.26 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,754.40 / $10,715.19
| Facility | | $1,621.81 | $5,754.40 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,737.80 / $2,754.23
| Professional | | $1,445.44 | $1,737.80 | $2,754.23 |