- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,570.88 / $10,964.78
| Facility | | $1,659.59 | $4,570.88 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,398.83 / $4,466.84
| Professional | | $1,995.26 | $2,398.83 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $8,912.51 / $16,982.44
| Facility | | $3,388.44 | $8,912.51 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,511.89 / $4,786.30
| Professional | | $1,905.46 | $2,511.89 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $3,801.89 / $10,715.19
| Facility | | $371.54 | $3,801.89 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,951.21 / $6,025.60
| Professional | | $1,819.70 | $2,951.21 | $6,025.60 |
- 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
- $1,819.70 / $2,511.89 / $4,570.88
| Professional | | $1,819.70 | $2,511.89 | $4,570.88 |