- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,344.23 / $4,897.79
| Facility | | $1,659.59 | $2,344.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,737.80 / $3,715.35
| Professional | | $1,513.56 | $1,737.80 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $40,738.03 / $57,543.99
| Facility | | $16,982.44 | $40,738.03 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,511.89 / $3,890.45
| Professional | | $1,513.56 | $2,511.89 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,584.89 / $1,698.24
| Facility | | $1,445.44 | $1,584.89 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,187.76 / $4,466.84
| Professional | | $1,548.82 | $2,187.76 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,754.40 / $12,022.64
| Facility | | $1,412.54 | $5,754.40 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,905.46 / $3,162.28
| Professional | | $1,412.54 | $1,905.46 | $3,162.28 |