- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,495.41 / $10,715.19
| Facility | | $1,819.70 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $524.81 / $1,000.00
| Professional | | $109.65 | $524.81 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,467.37 / $8,511.38
| Facility | | $2,454.71 | $3,467.37 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $512.86 / $1,202.26
| Professional | | $151.36 | $512.86 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $380.19 / $1,412.54
| Professional | | $173.78 | $380.19 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $891.25 / $2,137.96
| Professional | | $147.91 | $891.25 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $616.60 / $630.96
| Professional | | $107.15 | $616.60 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,290.87 / $3,890.45
| Facility | | $1,258.93 | $2,290.87 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $812.83 / $1,548.82
| Professional | | $169.82 | $812.83 | $1,548.82 |