- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,570.88 / $9,772.37
| Facility | | $2,238.72 | $4,570.88 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,380.38 / $2,691.53
| Professional | | $1,202.26 | $1,380.38 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $18,197.01 / $28,840.32
| Facility | | $5,623.41 | $18,197.01 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,630.27 / $3,890.45
| Professional | | $1,258.93 | $2,630.27 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,995.26 / $3,548.13
| Professional | | $691.83 | $1,995.26 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,388.44 / $7,413.10
| Facility | | $446.68 | $3,388.44 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,041.74 / $3,311.31
| Professional | | $1,412.54 | $2,041.74 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $3,388.44 / $7,413.10
| Facility | | $446.68 | $3,388.44 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,041.74 / $3,630.78
| Professional | | $1,380.38 | $2,041.74 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,412.54 / $1,659.59
| Facility | | $977.24 | $1,412.54 | $1,659.59 |