- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,897.79 / $11,481.54
| Facility | | $1,348.96 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,000.00 / $2,511.89
| Professional | | $812.83 | $1,000.00 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $7,585.78 / $14,791.08
| Facility | | $2,630.27 | $7,585.78 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,148.15 / $2,137.96
| Professional | | $831.76 | $1,148.15 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,570.40 / $7,413.10
| Facility | | $1,122.02 | $2,570.40 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,348.96 / $3,019.95
| Professional | | $891.25 | $1,348.96 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,951.21 / $6,456.54
| Facility | | $1,023.29 | $2,951.21 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,122.02 / $2,089.30
| Professional | | $794.33 | $1,122.02 | $2,089.30 |