- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,146.40 / $9,577.00 / $14,552.94
| Facility | | $2,146.40 | $9,577.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.48 / $2,495.14 / $3,640.37
| Professional | | $480.48 | $2,495.14 | $3,640.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,036.45 / $1,491.54 / $3,397.64
| Professional | | $1,036.45 | $1,491.54 | $3,397.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.44 / $2,495.14 / $5,096.52
| Facility | | $518.44 | $2,495.14 | $5,096.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,290.63 / $2,292.06 / $4,605.89
| Professional | | $1,290.63 | $2,292.06 | $4,605.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,969.00 / $2,848.86 / $4,106.00
| Professional | | $1,969.00 | $2,848.86 | $4,106.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.53 / $2,744.65 / $5,096.52
| Facility | | $525.53 | $2,744.65 | $5,096.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,073.19 / $2,580.00 / $4,100.25
| Professional | | $1,073.19 | $2,580.00 | $4,100.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,601.58 / $2,802.77 / $3,523.48
| Professional | | $1,601.58 | $2,802.77 | $3,523.48 |