- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,570.88 / $10,964.78
| Facility | | $1,621.81 | $4,570.88 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,905.46 / $3,548.13
| Professional | | $1,548.82 | $1,905.46 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $10,000.00 / $19,498.45
| Facility | | $3,467.37 | $10,000.00 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,949.84 / $3,715.35
| Professional | | $1,479.11 | $1,949.84 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,951.21 / $7,079.46
| Facility | | $398.11 | $2,951.21 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,290.87 / $4,786.30
| Professional | | $1,445.44 | $2,290.87 | $4,786.30 |
- 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
- $1,445.44 / $1,995.26 / $3,630.78
| Professional | | $1,445.44 | $1,995.26 | $3,630.78 |