- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,921.46 / $4,716.50 / $9,109.84
| Facility | | $1,921.46 | $4,716.50 | $9,109.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,800.68 / $2,032.00 / $2,574.44
| Professional | | $1,800.68 | $2,032.00 | $2,574.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $6,548.00 / $10,517.23
| Facility | | $3,302.10 | $6,548.00 | $10,517.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.36 / $2,226.92 / $3,403.53
| Professional | | $297.36 | $2,226.92 | $3,403.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,251.84 / $2,251.84 / $2,912.12
| Facility | | $2,251.84 | $2,251.84 | $2,912.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.44 / $842.71 / $1,584.35
| Professional | | $630.44 | $842.71 | $1,584.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $3,951.00 / $7,934.00
| Facility | | $1,981.00 | $3,951.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,421.44 / $3,424.47 / $5,624.69
| Professional | | $2,421.44 | $3,424.47 | $5,624.69 |