- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $6,456.54 / $15,135.61
| Facility | | $1,584.89 | $6,456.54 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,202.26 / $2,754.23
| Professional | | $977.24 | $1,202.26 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $13,489.63 / $28,840.32
| Facility | | $5,011.87 | $13,489.63 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,548.82 / $2,818.38
| Professional | | $977.24 | $1,548.82 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,365.16 / $19,952.62
| Facility | | $1,348.96 | $4,365.16 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,698.24 / $3,630.78
| Professional | | $1,071.52 | $1,698.24 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,912.51 / $20,417.38
| Facility | | $3,019.95 | $8,912.51 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,412.54 / $2,570.40
| Professional | | $1,000.00 | $1,412.54 | $2,570.40 |