- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,715.35 / $9,772.37
| Facility | | $1,258.93 | $3,715.35 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,288.25 / $2,691.53
| Professional | | $1,000.00 | $1,288.25 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,495.41 / $12,302.69
| Facility | | $1,949.84 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,318.26 / $2,630.27
| Professional | | $977.24 | $1,318.26 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $2,691.53 / $8,511.38
| Facility | | $50.12 | $2,691.53 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,621.81 / $3,890.45
| Professional | | $954.99 | $1,621.81 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,862.09 / $4,677.35
| Facility | | $467.74 | $1,862.09 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,258.93 / $2,398.83
| Professional | | $912.01 | $1,258.93 | $2,398.83 |