- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,888.44 / $10,964.78
| Facility | | $4,466.84 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $2,238.72
| Professional | | $1,479.11 | $1,479.11 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $575.44 / $1,122.02
| Facility | | $446.68 | $575.44 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,388.44 / $3,630.78
| Professional | | $1,778.28 | $3,388.44 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,265.80 / $5,370.32
| Professional | | $2,570.40 | $4,265.80 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,691.53 / $10,471.29
| Facility | | $1,318.26 | $2,691.53 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,318.26 / $2,454.71
| Professional | | $933.25 | $1,318.26 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,995.26 / $3,311.31
| Facility | | $1,000.00 | $1,995.26 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,318.26 / $2,454.71
| Professional | | $1,258.93 | $1,318.26 | $2,454.71 |