- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,619.69 / $9,577.00 / $14,552.94
| Facility | | $1,619.69 | $9,577.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.48 / $2,078.27 / $2,747.04
| Professional | | $379.48 | $2,078.27 | $2,747.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,046.54 / $1,420.49 / $2,429.71
| Professional | | $1,046.54 | $1,420.49 | $2,429.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.04 / $2,078.27 / $3,845.86
| Facility | | $501.04 | $2,078.27 | $3,845.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,003.55 / $1,648.71 / $3,313.05
| Professional | | $1,003.55 | $1,648.71 | $3,313.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,544.40 / $2,297.69 / $3,344.00
| Professional | | $1,544.40 | $2,297.69 | $3,344.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $516.72 / $2,286.10 / $3,845.86
| Facility | | $516.72 | $2,286.10 | $3,845.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $843.66 / $2,127.50 / $3,260.40
| Professional | | $843.66 | $2,127.50 | $3,260.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,516.46 / $2,653.81 / $3,336.21
| Professional | | $1,516.46 | $2,653.81 | $3,336.21 |