- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,888.44 / $10,715.19
| Facility | | $3,090.30 | $5,888.44 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $426.58 / $1,230.27
| Professional | | $346.74 | $426.58 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $537.03 / $1,318.26
| Professional | | $371.54 | $537.03 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $616.60 / $851.14
| Professional | | $389.05 | $616.60 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,370.32 / $8,128.31
| Facility | | $3,235.94 | $5,370.32 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $512.86 / $1,621.81
| Professional | | $363.08 | $512.86 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,019.95 / $7,762.47
| Facility | | $1,412.54 | $3,019.95 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $446.68 / $1,000.00
| Professional | | $309.03 | $446.68 | $1,000.00 |