- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,466.84 / $10,964.78
| Facility | | $1,584.89 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,041.74 / $3,890.45
| Professional | | $1,548.82 | $2,041.74 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $10,964.78 / $20,892.96
| Facility | | $3,801.89 | $10,964.78 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,398.83 / $4,570.88
| Professional | | $1,412.54 | $2,398.83 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $4,570.88 / $11,748.98
| Facility | | $398.11 | $4,570.88 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,818.38 / $5,754.40
| Professional | | $1,778.28 | $2,818.38 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,511.38 / $18,197.01
| Facility | | $2,951.21 | $8,511.38 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,344.23 / $4,265.80
| Professional | | $1,584.89 | $2,344.23 | $4,265.80 |