- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $6,025.60 / $16,982.44
| Facility | | $1,513.56 | $6,025.60 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,202.26 / $3,162.28
| Professional | | $1,000.00 | $1,202.26 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,548.82 / $3,019.95
| Professional | | $1,479.11 | $1,548.82 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $60.26 / $4,466.84
| Professional | | $32.36 | $60.26 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,819.70 / $2,398.83
| Professional | | $1,380.38 | $1,819.70 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $2,238.72 / $2,884.03
| Professional | | $912.01 | $2,238.72 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,698.24 / $2,570.40
| Professional | | $1,445.44 | $1,698.24 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,128.61 / $13,803.84
| Facility | | $2,290.87 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,380.38 / $2,290.87
| Professional | | $1,047.13 | $1,380.38 | $2,290.87 |