- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $4,168.69 / $15,848.93
| Facility | | $2,398.83 | $4,168.69 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,148.15 / $3,235.94
| Professional | | $1,023.29 | $1,148.15 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $10,471.29 / $19,952.62
| Facility | | $9,332.54 | $10,471.29 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,041.74 / $2,884.03
| Professional | | $1,023.29 | $2,041.74 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $2,187.76 / $3,388.44
| Professional | | $467.74 | $2,187.76 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $11,220.18
| Facility | | $11,220.18 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,862.09 / $3,162.28
| Professional | | $1,148.15 | $1,862.09 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $11,220.18
| Facility | | $11,220.18 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,949.84 / $3,548.13
| Professional | | $1,318.26 | $1,949.84 | $3,548.13 |