- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,365.16 / $10,715.19
| Facility | | $851.14 | $4,365.16 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $467.74 / $1,047.13
| Professional | | $380.19 | $467.74 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $8,128.31 / $15,488.17
| Facility | | $2,454.71 | $8,128.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $575.44 / $1,071.52
| Professional | | $380.19 | $575.44 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,288.25 / $3,090.30
| Facility | | $645.65 | $1,288.25 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $660.69 / $1,348.96
| Professional | | $426.58 | $660.69 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,495.41 / $12,302.69
| Facility | | $1,949.84 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $549.54 / $1,000.00
| Professional | | $389.05 | $549.54 | $1,000.00 |