- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $6,165.95 / $9,772.37
| Facility | | $2,398.83 | $6,165.95 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,819.70 / $3,630.78
| Professional | | $1,621.81 | $1,819.70 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $10,964.78 / $16,982.44
| Facility | | $3,890.45 | $10,964.78 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,548.13 / $5,248.07
| Professional | | $1,698.24 | $3,548.13 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,630.27 / $4,786.30
| Professional | | $1,096.48 | $2,630.27 | $4,786.30 |
- 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
- $1,905.46 / $2,754.23 / $4,466.84
| Professional | | $1,905.46 | $2,754.23 | $4,466.84 |
- 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
- $1,862.09 / $2,754.23 / $4,897.79
| Professional | | $1,862.09 | $2,754.23 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,819.70 / $2,238.72
| Facility | | $1,318.26 | $1,819.70 | $2,238.72 |