- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $6,606.93 / $10,471.29
| Facility | | $1,905.46 | $6,606.93 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,513.56 / $1,819.70
| Professional | | $1,071.52 | $1,513.56 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,495.41 / $9,120.11
| Facility | | $2,454.71 | $5,495.41 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $1,905.46
| Professional | | $794.33 | $794.33 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,230.27 / $5,754.40
| Facility | | $1,000.00 | $1,230.27 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,344.23 / $2,754.23
| Professional | | $2,290.87 | $2,344.23 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,630.27 / $2,691.53
| Professional | | $2,630.27 | $2,630.27 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,905.46 / $1,905.46
| Professional | | $1,318.26 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $1,148.15
| Professional | | $794.33 | $794.33 | $1,148.15 |