- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,466.84 / $10,964.78
| Facility | | $1,584.89 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,778.28 / $3,548.13
| Professional | | $1,479.11 | $1,778.28 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $10,471.29 / $19,498.45
| Facility | | $3,890.45 | $10,471.29 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,238.72 / $4,073.80
| Professional | | $1,548.82 | $2,238.72 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $5,248.07 / $14,791.08
| Facility | | $323.59 | $5,248.07 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,570.40 / $5,623.41
| Professional | | $1,584.89 | $2,570.40 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,128.61 / $12,022.64
| Facility | | $1,819.70 | $5,128.61 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,137.96 / $3,801.89
| Professional | | $1,479.11 | $2,137.96 | $3,801.89 |