- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,128.61 / $12,302.69
| Facility | | $2,454.71 | $5,128.61 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,344.23 / $2,818.38
| Professional | | $1,513.56 | $2,344.23 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,011.87 / $14,454.40
| Facility | | $2,884.03 | $5,011.87 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $1,445.44 / $4,073.80
| Professional | | $100.00 | $1,445.44 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,754.40 / $12,882.50
| Facility | | $1,949.84 | $5,754.40 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,365.16 / $8,317.64
| Professional | | $3,467.37 | $4,365.16 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,019.95 / $3,630.78
| Facility | | $1,819.70 | $3,019.95 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,819.70 / $3,630.78
| Professional | | $1,258.93 | $1,819.70 | $3,630.78 |