- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,128.61 / $12,882.50
| Facility | | $1,148.15 | $5,128.61 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,000.00 / $2,187.76
| Professional | | $851.14 | $1,000.00 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $9,120.11 / $17,378.01
| Facility | | $3,388.44 | $9,120.11 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,230.27 / $2,344.23
| Professional | | $851.14 | $1,230.27 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $2,630.27 / $6,918.31
| Facility | | $323.59 | $2,630.27 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,412.54 / $2,951.21
| Professional | | $933.25 | $1,412.54 | $2,951.21 |
- 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
- $794.33 / $1,122.02 / $2,089.30
| Professional | | $794.33 | $1,122.02 | $2,089.30 |