- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,326.28 / $4,243.50 / $8,861.13
| Facility | | $1,326.28 | $4,243.50 | $8,861.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $962.92 / $1,092.52 / $1,673.40
| Professional | | $962.92 | $1,092.52 | $1,673.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,977.00 / $9,830.00 / $22,609.00
| Facility | | $4,977.00 | $9,830.00 | $22,609.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,010.43 / $1,352.10 / $2,138.64
| Professional | | $1,010.43 | $1,352.10 | $2,138.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,203.30 / $2,862.32 / $10,271.19
| Facility | | $1,203.30 | $2,862.32 | $10,271.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,070.01 / $1,535.32 / $2,336.41
| Professional | | $1,070.01 | $1,535.32 | $2,336.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $7,208.00 / $12,037.71
| Facility | | $2,912.00 | $7,208.00 | $12,037.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $945.77 / $1,337.02 / $2,313.50
| Professional | | $945.77 | $1,337.02 | $2,313.50 |