- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,212.78 / $4,375.52 / $10,229.50
| Facility | | $1,212.78 | $4,375.52 | $10,229.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.18 / $1,575.73 / $2,788.42
| Professional | | $741.18 | $1,575.73 | $2,788.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,877.00 / $7,264.00 / $12,538.00
| Facility | | $3,877.00 | $7,264.00 | $12,538.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $792.81 / $1,077.40 / $1,988.59
| Professional | | $792.81 | $1,077.40 | $1,988.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,394.89 / $3,906.58 / $4,722.83
| Facility | | $1,394.89 | $3,906.58 | $4,722.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $909.59 / $1,859.04 / $3,838.08
| Professional | | $909.59 | $1,859.04 | $3,838.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $6,231.00 / $11,869.99
| Facility | | $2,912.00 | $6,231.00 | $11,869.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,676.67 / $2,396.26 / $4,287.51
| Professional | | $1,676.67 | $2,396.26 | $4,287.51 |