- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,365.16 / $10,964.78
| Facility | | $1,230.27 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,096.48 / $2,398.83
| Professional | | $891.25 | $1,096.48 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $7,762.47 / $16,218.10
| Facility | | $2,884.03 | $7,762.47 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,412.54 / $2,630.27
| Professional | | $870.96 | $1,412.54 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,884.03 / $6,918.31
| Facility | | $1,698.24 | $2,884.03 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,548.82 / $3,162.28
| Professional | | $1,000.00 | $1,548.82 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,918.31 / $15,488.17
| Facility | | $2,454.71 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,258.93 / $2,238.72
| Professional | | $851.14 | $1,258.93 | $2,238.72 |