- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,365.16 / $10,964.78
| Facility | | $1,230.27 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,047.13 / $2,290.87
| Professional | | $912.01 | $1,047.13 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $8,317.64 / $15,488.17
| Facility | | $3,090.30 | $8,317.64 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,412.54 / $2,511.89
| Professional | | $912.01 | $1,412.54 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,630.27 / $7,244.36
| Facility | | $1,202.26 | $2,630.27 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,548.82 / $3,162.28
| Professional | | $1,000.00 | $1,548.82 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,754.40 / $14,125.38
| Facility | | $1,949.84 | $5,754.40 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,230.27 / $2,238.72
| Professional | | $851.14 | $1,230.27 | $2,238.72 |