- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,570.88 / $11,481.54
| Facility | | $1,258.93 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,318.26 / $2,691.53
| Professional | | $1,122.02 | $1,318.26 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $7,079.46 / $17,378.01
| Facility | | $3,311.31 | $7,079.46 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,584.89 / $2,951.21
| Professional | | $1,071.52 | $1,584.89 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,548.13 / $10,000.00
| Facility | | $323.59 | $3,548.13 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,819.70 / $3,890.45
| Professional | | $1,148.15 | $1,819.70 | $3,890.45 |
- 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
- $1,047.13 / $1,479.11 / $2,754.23
| Professional | | $1,047.13 | $1,479.11 | $2,754.23 |