- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,786.30 / $11,748.98
| Facility | | $1,479.11 | $4,786.30 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,137.96 / $7,585.78
| Professional | | $1,000.00 | $2,137.96 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $11,481.54 / $26,915.35
| Facility | | $5,248.07 | $11,481.54 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $1,288.25 / $2,951.21
| Professional | | $537.03 | $1,288.25 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $11,481.54 / $30,199.52
| Facility | | $5,495.41 | $11,481.54 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,168.69 / $23,988.33
| Professional | | $2,344.23 | $4,168.69 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $11,220.18 / $26,302.68
| Facility | | $3,630.78 | $11,220.18 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,659.59 / $4,786.30
| Professional | | $1,023.29 | $1,659.59 | $4,786.30 |