- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,677.35 / $10,964.78
| Facility | | $1,148.15 | $4,677.35 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $870.96 / $1,000.00
| Professional | | $575.44 | $870.96 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,495.41 / $12,022.64
| Facility | | $2,290.87 | $5,495.41 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $954.99 / $1,737.80
| Professional | | $251.19 | $954.99 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,230.27 / $1,659.59
| Facility | | $562.34 | $1,230.27 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,365.16 / $4,365.16
| Professional | | $1,445.44 | $4,365.16 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $2,630.27 / $6,309.57
| Facility | | $676.08 | $2,630.27 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,096.48 / $1,905.46
| Professional | | $758.58 | $1,096.48 | $1,905.46 |