- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,606.52 / $4,186.22 / $8,625.21
| Facility | | $2,606.52 | $4,186.22 | $8,625.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,211.59 / $2,559.13 / $2,843.48
| Professional | | $2,211.59 | $2,559.13 | $2,843.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,050.00 / $4,636.45 / $12,321.74
| Facility | | $1,050.00 | $4,636.45 | $12,321.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.00 / $600.00 / $3,159.42
| Professional | | $500.00 | $600.00 | $3,159.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,567.03 / $5,288.07 / $9,652.01
| Facility | | $2,567.03 | $5,288.07 | $9,652.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,848.09 / $3,848.09 / $4,610.43
| Professional | | $3,848.09 | $3,848.09 | $4,610.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,895.65 / $3,159.42 / $3,791.30
| Facility | | $1,895.65 | $3,159.42 | $3,791.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.96 / $1,895.65 / $3,633.33
| Professional | | $1,326.96 | $1,895.65 | $3,633.33 |