- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $4,570.88 / $11,220.18
| Facility | | $1,174.90 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,122.02 / $2,344.23
| Professional | | $912.01 | $1,122.02 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $11,220.18 / $22,908.68
| Facility | | $3,981.07 | $11,220.18 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,258.93 / $2,570.40
| Professional | | $758.58 | $1,258.93 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,949.84 / $7,943.28
| Facility | | $398.11 | $1,949.84 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,548.82 / $3,388.44
| Professional | | $1,000.00 | $1,548.82 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $19,054.61
| Facility | | $3,019.95 | $8,709.64 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,230.27 / $2,344.23
| Professional | | $870.96 | $1,230.27 | $2,344.23 |