- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,630.27 / $6,456.54
| Facility | | $1,148.15 | $2,630.27 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,148.15 / $1,412.54
| Professional | | $1,000.00 | $1,148.15 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $2,630.27 / $3,548.13
| Facility | | $245.47 | $2,630.27 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,348.96 / $2,454.71
| Professional | | $912.01 | $1,348.96 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,691.53 / $8,511.38
| Facility | | $1,202.26 | $2,691.53 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,949.84 / $4,265.80
| Professional | | $1,096.48 | $1,949.84 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,041.74 / $3,630.78
| Facility | | $1,000.00 | $2,041.74 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,288.25 / $2,398.83
| Professional | | $851.14 | $1,288.25 | $2,398.83 |