- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $5,623.41 / $14,125.38
| Facility | | $1,479.11 | $5,623.41 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,174.90 / $2,818.38
| Professional | | $977.24 | $1,174.90 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $10,471.29 / $19,952.62
| Facility | | $3,801.89 | $10,471.29 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,380.38 / $2,570.40
| Professional | | $954.99 | $1,380.38 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $3,090.30 / $8,912.51
| Facility | | $323.59 | $3,090.30 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,584.89 / $3,388.44
| Professional | | $1,000.00 | $1,584.89 | $3,388.44 |
- 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
- $912.01 / $1,318.26 / $2,398.83
| Professional | | $912.01 | $1,318.26 | $2,398.83 |