- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,570.88 / $11,748.98
| Facility | | $1,230.27 | $4,570.88 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,230.27 / $3,801.89
| Professional | | $977.24 | $1,230.27 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $11,481.54 / $22,908.68
| Facility | | $3,981.07 | $11,481.54 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,412.54 / $2,951.21
| Professional | | $912.01 | $1,412.54 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,715.35 / $26,915.35
| Facility | | $1,659.59 | $3,715.35 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,698.24 / $4,265.80
| Professional | | $977.24 | $1,698.24 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,235.94 / $13,803.84
| Facility | | $851.14 | $3,235.94 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,380.38 / $3,388.44
| Professional | | $912.01 | $1,380.38 | $3,388.44 |