- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,897.79 / $11,481.54
| Facility | | $1,445.44 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,148.15 / $2,511.89
| Professional | | $1,000.00 | $1,148.15 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $8,317.64 / $15,848.93
| Facility | | $3,162.28 | $8,317.64 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,548.82 / $2,818.38
| Professional | | $1,023.29 | $1,548.82 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,454.71 / $7,943.28
| Facility | | $1,348.96 | $2,454.71 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,698.24 / $3,548.13
| Professional | | $1,122.02 | $1,698.24 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $6,918.31 / $15,488.17
| Facility | | $2,398.83 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,348.96 / $2,454.71
| Professional | | $933.25 | $1,348.96 | $2,454.71 |