- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,995.26 / $4,466.84
| Facility | | $1,023.29 | $1,995.26 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,122.02 / $2,187.76
| Professional | | $1,000.00 | $1,122.02 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $3,630.78
| Facility | | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $3,467.37
| Professional | | $2,137.96 | $2,137.96 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,630.78 / $3,981.07
| Facility | | $3,235.94 | $3,630.78 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,778.28 / $2,290.87
| Professional | | $1,122.02 | $1,778.28 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $4,073.80 / $12,302.69
| Facility | | $977.24 | $4,073.80 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,288.25 / $2,570.40
| Professional | | $977.24 | $1,288.25 | $2,570.40 |