- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,981.07 / $10,964.78
| Facility | | $1,202.26 | $3,981.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $2,137.96 / $2,691.53
| Professional | | $457.09 | $2,137.96 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,570.88 / $13,182.57
| Facility | | $1,778.28 | $4,570.88 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $263.03 / $3,090.30
| Professional | | $208.93 | $263.03 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $5,248.07 / $12,302.69
| Facility | | $1,778.28 | $5,248.07 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,981.07 / $8,128.31
| Professional | | $3,162.28 | $3,981.07 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,754.23 / $3,311.31
| Facility | | $1,659.59 | $2,754.23 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,659.59 / $3,311.31
| Professional | | $1,148.15 | $1,659.59 | $3,311.31 |