- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,014.24 / $1,397.00 / $4,478.00
| Facility | | $1,014.24 | $1,397.00 | $4,478.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $757.86 / $1,014.24 / $1,213.95
| Professional | | $757.86 | $1,014.24 | $1,213.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,308.46 / $3,308.46 / $3,970.15
| Facility | | $3,308.46 | $3,308.46 | $3,970.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $936.11 / $1,170.14 / $1,376.63
| Professional | | $936.11 | $1,170.14 | $1,376.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,414.94 / $2,414.94 / $2,414.94
| Facility | | $2,414.94 | $2,414.94 | $2,414.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.07 / $1,131.58 / $1,417.44
| Professional | | $591.07 | $1,131.58 | $1,417.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.00 / $2,311.00 / $5,652.00
| Facility | | $1,240.00 | $2,311.00 | $5,652.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $788.49 / $1,000.55 / $1,728.73
| Professional | | $788.49 | $1,000.55 | $1,728.73 |