- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $10,715.19 / $14,125.38
| Facility | | $1,479.11 | $10,715.19 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $691.83 / $1,621.81
| Professional | | $446.68 | $691.83 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,621.81 / $2,818.38
| Professional | | $1,202.26 | $1,621.81 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,000.00 / $3,388.44
| Facility | | $446.68 | $1,000.00 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,905.46 / $3,162.28
| Professional | | $1,148.15 | $1,905.46 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,630.27 / $3,630.78
| Professional | | $1,737.80 | $2,630.27 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $831.76 / $3,388.44
| Facility | | $478.63 | $831.76 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $891.25 / $1,621.81
| Professional | | $60.26 | $891.25 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $2,290.87 / $3,467.37
| Professional | | $630.96 | $2,290.87 | $3,467.37 |