- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $6,606.93 / $8,709.64
| Facility | | $1,905.46 | $6,606.93 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,691.53 / $2,818.38
| Professional | | $1,348.96 | $2,691.53 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $16,595.87 / $17,782.79
| Facility | | $16,595.87 | $16,595.87 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,884.03 / $3,801.89
| Professional | | $2,691.53 | $2,884.03 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $6,918.31 / $15,488.17
| Facility | | $1,778.28 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,258.93 / $2,818.38
| Professional | | $1,230.27 | $1,258.93 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,570.40 / $5,011.87
| Facility | | $1,905.46 | $2,570.40 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,691.53 / $3,235.94
| Facility | | $2,454.71 | $2,691.53 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,621.81 / $2,691.53
| Professional | | $1,148.15 | $1,621.81 | $2,691.53 |