- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,238.72 / $5,370.32
| Facility | | $1,548.82 | $2,238.72 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $1,023.29 / $2,511.89
| Professional | | $389.05 | $1,023.29 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,137.96 / $4,265.80
| Facility | | $1,737.80 | $2,137.96 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,000.00 / $2,344.23
| Professional | | $363.08 | $1,000.00 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $1,174.90 / $12,022.64
| Facility | | $288.40 | $1,174.90 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,621.81 / $3,162.28
| Professional | | $954.99 | $1,621.81 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $758.58 / $2,398.83
| Professional | | $257.04 | $758.58 | $2,398.83 |