- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $12,022.64 / $23,442.29
| Facility | | $3,235.94 | $12,022.64 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,380.38 / $3,235.94
| Professional | | $1,000.00 | $1,380.38 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,630.78 / $4,786.30
| Professional | | $2,691.53 | $3,630.78 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,659.59 / $7,585.78
| Facility | | $1,000.00 | $1,659.59 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,311.31 / $6,025.60
| Professional | | $2,398.83 | $3,311.31 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,570.88 / $6,309.57
| Professional | | $3,467.37 | $4,570.88 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,621.81 / $5,888.44
| Facility | | $1,023.29 | $1,621.81 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,513.56 / $3,630.78
| Professional | | $60.26 | $1,513.56 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,897.79 / $6,309.57
| Professional | | $1,258.93 | $4,897.79 | $6,309.57 |