- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,897.79 / $10,471.29
| Facility | | $2,041.74 | $4,897.79 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,258.93 / $2,454.71
| Professional | | $1,000.00 | $1,258.93 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $16,218.10 / $18,620.87
| Facility | | $8,709.64 | $16,218.10 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $2,089.30 / $2,691.53
| Professional | | $954.99 | $2,089.30 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,737.80 / $2,884.03
| Professional | | $1,258.93 | $1,737.80 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,905.46
| Professional | | $1,698.24 | $1,698.24 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,165.95 / $15,135.61
| Facility | | $3,311.31 | $6,165.95 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,380.38 / $3,090.30
| Professional | | $1,000.00 | $1,380.38 | $3,090.30 |