- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,248.07 / $12,589.25
| Facility | | $1,348.96 | $5,248.07 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,096.48 / $2,398.83
| Professional | | $954.99 | $1,096.48 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $11,220.18 / $26,302.68
| Facility | | $3,715.35 | $11,220.18 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,380.38 / $2,630.27
| Professional | | $933.25 | $1,380.38 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,162.28 / $10,000.00
| Facility | | $1,819.70 | $3,162.28 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,548.82 / $3,311.31
| Professional | | $1,023.29 | $1,548.82 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,585.78 / $18,620.87
| Facility | | $2,454.71 | $7,585.78 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,230.27 / $2,290.87
| Professional | | $891.25 | $1,230.27 | $2,290.87 |