- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,466.84 / $10,964.78
| Facility | | $1,445.44 | $4,466.84 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,584.89 / $3,467.37
| Professional | | $1,258.93 | $1,584.89 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $7,762.47 / $16,218.10
| Facility | | $2,884.03 | $7,762.47 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,905.46 / $3,630.78
| Professional | | $1,202.26 | $1,905.46 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,162.28 / $10,000.00
| Facility | | $1,819.70 | $3,162.28 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,137.96 / $4,570.88
| Professional | | $1,380.38 | $2,137.96 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,244.36 / $17,378.01
| Facility | | $2,454.71 | $7,244.36 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,737.80 / $3,162.28
| Professional | | $1,202.26 | $1,737.80 | $3,162.28 |