- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,691.53 / $6,456.54
| Facility | | $1,096.48 | $2,691.53 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,348.96 / $2,398.83
| Professional | | $1,148.15 | $1,348.96 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $7,585.78 / $13,182.57
| Facility | | $2,398.83 | $7,585.78 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,862.09 / $2,884.03
| Professional | | $1,202.26 | $1,862.09 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $512.86 / $2,137.96
| Facility | | $501.19 | $512.86 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,584.89 / $2,754.23
| Professional | | $1,122.02 | $1,584.89 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $22,387.21 / $22,387.21
| Facility | | $2,818.38 | $22,387.21 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,912.51 / $10,964.78 / $10,964.78
| Professional | | $8,912.51 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $10,000.00 / $19,498.45
| Facility | | $4,897.79 | $10,000.00 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,445.44 / $2,344.23
| Professional | | $1,047.13 | $1,445.44 | $2,344.23 |