- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $7,943.28 / $16,595.87
| Facility | | $1,412.54 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,230.27 / $2,454.71
| Professional | | $1,000.00 | $1,230.27 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,258.93 / $2,089.30
| Professional | | $912.01 | $1,258.93 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,412.54 / $2,344.23
| Professional | | $1,047.13 | $1,412.54 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,479.11 / $2,630.27
| Facility | | $1,071.52 | $1,479.11 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,760.83 / $9,120.11
| Facility | | $2,454.71 | $6,760.83 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,348.96 / $2,344.23
| Professional | | $1,000.00 | $1,348.96 | $2,344.23 |