- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,128.21 / $4,676.39 / $13,301.40
| Facility | | $2,128.21 | $4,676.39 | $13,301.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,330.14 / $1,330.14 / $1,539.16
| Professional | | $1,330.14 | $1,330.14 | $1,539.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,125.83 / $3,473.57 / $7,410.78
| Facility | | $3,125.83 | $3,473.57 | $7,410.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.00 / $1,235.13 / $1,235.13
| Professional | | $500.00 | $1,235.13 | $1,235.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,335.31 / $5,965.68 / $6,946.39
| Facility | | $4,335.31 | $5,965.68 | $6,946.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,900.20 / $2,578.94 / $5,864.97
| Professional | | $1,900.20 | $2,578.94 | $5,864.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.08 / $1,140.11 / $1,900.20
| Professional | | $798.08 | $1,140.11 | $1,900.20 |