- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,981.07 / $8,709.64
| Facility | | $1,202.26 | $3,981.07 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $602.56 / $1,202.26
| Professional | | $478.63 | $602.56 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,549.93 / $17,378.01
| Facility | | $4,570.88 | $9,549.93 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $676.08 / $933.25
| Professional | | $537.03 | $676.08 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $741.31 / $1,000.00
| Professional | | $575.44 | $741.31 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $616.60 / $1,949.84
| Professional | | $602.56 | $616.60 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $489.78
| Professional | | $426.58 | $426.58 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,290.87 / $3,890.45
| Facility | | $1,258.93 | $2,290.87 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $741.31 / $1,288.25
| Professional | | $575.44 | $741.31 | $1,288.25 |