- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,677.35 / $11,220.18
| Facility | | $1,819.70 | $4,677.35 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,137.96 / $3,981.07
| Professional | | $1,778.28 | $2,137.96 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $10,471.29 / $19,498.45
| Facility | | $3,548.13 | $10,471.29 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,187.76 / $4,168.69
| Professional | | $1,621.81 | $2,187.76 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,388.44 / $9,549.93
| Facility | | $323.59 | $3,388.44 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,630.27 / $5,370.32
| Professional | | $1,621.81 | $2,630.27 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,818.38 / $9,772.37
| Facility | | $537.03 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,238.72 / $4,073.80
| Professional | | $1,621.81 | $2,238.72 | $4,073.80 |