- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,123.17 / $10,175.36 / $13,413.92
| Facility | | $1,123.17 | $10,175.36 | $13,413.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.27 / $1,303.61 / $1,904.94
| Professional | | $244.27 | $1,303.61 | $1,904.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $654.92 / $986.25 / $1,745.16
| Professional | | $654.92 | $986.25 | $1,745.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $282.48 / $1,303.61 / $2,666.92
| Facility | | $282.48 | $1,303.61 | $2,666.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.98 / $1,166.40 / $2,343.90
| Professional | | $650.98 | $1,166.40 | $2,343.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,006.25 / $1,520.00 / $2,384.00
| Professional | | $1,006.25 | $1,520.00 | $2,384.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.79 / $1,433.98 / $2,666.92
| Facility | | $338.79 | $1,433.98 | $2,666.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.41 / $1,470.47 / $2,330.25
| Professional | | $581.41 | $1,470.47 | $2,330.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.48 / $1,845.34 / $2,319.86
| Professional | | $1,054.48 | $1,845.34 | $2,319.86 |