- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,897.79 / $11,481.54
| Facility | | $1,479.11 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,380.38 / $2,951.21
| Professional | | $1,000.00 | $1,380.38 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $8,912.51 / $17,782.79
| Facility | | $3,235.94 | $8,912.51 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,380.38 / $2,754.23
| Professional | | $831.76 | $1,380.38 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,801.89 / $9,120.11
| Facility | | $1,995.26 | $3,801.89 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,698.24 / $3,981.07
| Professional | | $977.24 | $1,698.24 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,677.35 / $10,964.78
| Facility | | $1,584.89 | $4,677.35 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,348.96 / $2,691.53
| Professional | | $933.25 | $1,348.96 | $2,691.53 |