- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.39 / $2,797.23 / $134,935.94
| Facility | | $1,170.39 | $2,797.23 | $134,935.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,170.39 / $1,170.39 / $1,170.39
| Professional | | $1,170.39 | $1,170.39 | $1,170.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,353.22 / $2,140.60 / $3,901.31
| Facility | | $1,353.22 | $2,140.60 | $3,901.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,243.54 / $1,243.54 / $1,243.54
| Professional | | $1,243.54 | $1,243.54 | $1,243.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,243.54 / $1,243.54 / $1,243.54
| Facility | | $1,243.54 | $1,243.54 | $1,243.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,243.54 / $1,243.54 / $1,243.54
| Professional | | $1,243.54 | $1,243.54 | $1,243.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.39 / $1,170.39 / $1,736.42
| Facility | | $1,170.39 | $1,170.39 | $1,736.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,131.00 / $2,131.00 / $2,131.00
| Professional | | $2,131.00 | $2,131.00 | $2,131.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,219.16 / $1,219.16 / $1,219.16
| Professional | | $1,219.16 | $1,219.16 | $1,219.16 |