- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,137.96 / $8,709.64
| Facility | | $1,258.93 | $2,137.96 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,548.82 / $3,630.78
| Professional | | $1,258.93 | $1,548.82 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,884.03 / $3,630.78
| Professional | | $1,737.80 | $2,884.03 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,041.74 / $3,467.37
| Professional | | $1,380.38 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,949.84 / $3,311.31
| Facility | | $1,258.93 | $1,949.84 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,890.45 / $6,918.31
| Facility | | $1,174.90 | $3,890.45 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,862.09 / $3,235.94
| Professional | | $1,318.26 | $1,862.09 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $22,908.68 / $22,908.68
| Facility | | $56.23 | $22,908.68 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,471.29 / $10,471.29 / $10,964.78
| Professional | | $10,471.29 | $10,471.29 | $10,964.78 |