- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,162.28 / $8,128.31
| Facility | | $1,548.82 | $3,162.28 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,548.82 / $1,949.84
| Professional | | $354.81 | $1,548.82 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,311.31 / $9,332.54
| Facility | | $1,258.93 | $3,311.31 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $275.42 / $2,951.21
| Professional | | $239.88 | $275.42 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $3,162.28 / $7,585.78
| Facility | | $870.96 | $3,162.28 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,818.38 / $5,370.32
| Professional | | $2,238.72 | $2,818.38 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,949.84 / $2,344.23
| Facility | | $1,174.90 | $1,949.84 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,174.90 / $2,344.23
| Professional | | $812.83 | $1,174.90 | $2,344.23 |