- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,897.79 / $11,481.54
| Facility | | $1,819.70 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $1,862.09
| Professional | | $1,862.09 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $10,715.19 / $20,892.96
| Facility | | $3,801.89 | $10,715.19 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,905.46 / $4,073.80
| Professional | | $1,000.00 | $1,905.46 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $3,311.31 / $8,317.64
| Facility | | $34.67 | $3,311.31 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,630.27 / $4,073.80
| Professional | | $1,584.89 | $2,630.27 | $4,073.80 |
- 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
- $50.12 / $1,318.26 / $2,691.53
| Professional | | $50.12 | $1,318.26 | $2,691.53 |