- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.52 / $5,173.96 / $13,413.92
| Facility | | $2,424.52 | $5,173.96 | $13,413.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.18 / $1,130.17 / $3,834.37
| Professional | | $356.18 | $1,130.17 | $3,834.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,211.83 / $1,211.83 / $2,717.84
| Professional | | $1,211.83 | $1,211.83 | $2,717.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.43 / $2,284.35 / $5,368.12
| Facility | | $437.43 | $2,284.35 | $5,368.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $997.56 / $2,420.71 / $5,580.41
| Professional | | $997.56 | $2,420.71 | $5,580.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,377.00 / $2,241.15 / $4,804.22
| Professional | | $1,377.00 | $2,241.15 | $4,804.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.43 / $2,284.35 / $5,368.12
| Facility | | $437.43 | $2,284.35 | $5,368.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.80 / $1,955.82 / $4,804.22
| Professional | | $754.80 | $1,955.82 | $4,804.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,029.06 / $3,261.39 / $4,666.84
| Professional | | $2,029.06 | $3,261.39 | $4,666.84 |