- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $5,248.07 / $12,022.64
| Facility | | $1,380.38 | $5,248.07 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,174.90 / $2,754.23
| Professional | | $1,000.00 | $1,174.90 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $9,332.54 / $17,782.79
| Facility | | $3,388.44 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,412.54 / $2,691.53
| Professional | | $977.24 | $1,412.54 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,290.87 / $7,943.28
| Facility | | $398.11 | $2,290.87 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,621.81 / $3,467.37
| Professional | | $1,071.52 | $1,621.81 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $8,709.64 / $19,054.61
| Facility | | $2,884.03 | $8,709.64 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,288.25 / $2,454.71
| Professional | | $912.01 | $1,288.25 | $2,454.71 |