- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $10,715.19 / $14,125.38
| Facility | | $1,122.02 | $10,715.19 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $1,412.54 / $2,089.30
| Professional | | $398.11 | $1,412.54 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $3,890.45
| Professional | | $1,258.93 | $1,258.93 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $1,698.24 / $6,309.57
| Facility | | $478.63 | $1,698.24 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $3,019.95 / $7,413.10
| Professional | | $912.01 | $3,019.95 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,454.71 / $6,456.54
| Professional | | $1,548.82 | $2,454.71 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $2,951.21 / $8,912.51
| Facility | | $549.54 | $2,951.21 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $524.81 / $3,890.45
| Professional | | $60.26 | $524.81 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,344.23 / $5,754.40
| Professional | | $1,000.00 | $2,344.23 | $5,754.40 |