- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,570.88 / $11,481.54
| Facility | | $1,258.93 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,288.25 / $2,818.38
| Professional | | $1,047.13 | $1,288.25 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $12,022.64 / $23,988.33
| Facility | | $4,073.80 | $12,022.64 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,584.89 / $2,951.21
| Professional | | $1,023.29 | $1,584.89 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,884.03 / $7,762.47
| Facility | | $398.11 | $2,884.03 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,778.28 / $3,630.78
| Professional | | $1,096.48 | $1,778.28 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,445.44 / $2,630.27
| Professional | | $1,000.00 | $1,445.44 | $2,630.27 |