- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $4,466.84 / $10,715.19
| Facility | | $1,318.26 | $4,466.84 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,096.48 / $2,398.83
| Professional | | $354.81 | $1,096.48 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $11,481.54 / $23,988.33
| Facility | | $6,025.60 | $11,481.54 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $1,096.48 / $2,187.76
| Professional | | $380.19 | $1,096.48 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $794.33 / $2,137.96
| Professional | | $389.05 | $794.33 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $1,862.09 / $3,162.28
| Professional | | $436.52 | $1,862.09 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $1,122.02 / $1,318.26
| Professional | | $309.03 | $1,122.02 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $14,125.38 / $23,988.33
| Facility | | $10,232.93 | $14,125.38 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $1,000.00 / $2,238.72
| Professional | | $398.11 | $1,000.00 | $2,238.72 |