- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,570.88 / $11,220.18
| Facility | | $1,230.27 | $4,570.88 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,258.93 / $2,511.89
| Professional | | $1,023.29 | $1,258.93 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $9,332.54 / $17,378.01
| Facility | | $3,630.78 | $9,332.54 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,479.11 / $2,754.23
| Professional | | $1,000.00 | $1,479.11 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,818.38 / $7,762.47
| Facility | | $398.11 | $2,818.38 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,698.24 / $3,630.78
| Professional | | $1,047.13 | $1,698.24 | $3,630.78 |
- 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
- $977.24 / $1,412.54 / $2,570.40
| Professional | | $977.24 | $1,412.54 | $2,570.40 |