- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,128.61 / $12,022.64
| Facility | | $1,513.56 | $5,128.61 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,479.11 / $3,162.28
| Professional | | $1,202.26 | $1,479.11 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $7,943.28 / $15,848.93
| Facility | | $2,630.27 | $7,943.28 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,778.28 / $3,388.44
| Professional | | $1,202.26 | $1,778.28 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,019.95 / $10,232.93
| Facility | | $1,071.52 | $3,019.95 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,995.26 / $4,365.16
| Professional | | $1,318.26 | $1,995.26 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $6,309.57
| Facility | | $1,000.00 | $2,884.03 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,621.81 / $3,019.95
| Professional | | $1,148.15 | $1,621.81 | $3,019.95 |