- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,897.79 / $10,471.29
| Facility | | $1,698.24 | $4,897.79 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,023.29 / $2,570.40
| Professional | | $776.25 | $1,023.29 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $16,595.87 / $18,620.87
| Facility | | $8,709.64 | $16,595.87 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,698.24 / $2,187.76
| Professional | | $870.96 | $1,698.24 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,445.44 / $2,454.71
| Professional | | $1,000.00 | $1,445.44 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $1,737.80
| Professional | | $1,445.44 | $1,445.44 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,165.95 / $15,135.61
| Facility | | $3,311.31 | $6,165.95 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,230.27 / $2,290.87
| Professional | | $851.14 | $1,230.27 | $2,290.87 |