- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,570.88 / $11,481.54
| Facility | | $1,096.48 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,000.00 / $2,041.74
| Professional | | $812.83 | $1,000.00 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $8,511.38 / $17,782.79
| Facility | | $3,388.44 | $8,511.38 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,258.93 / $2,290.87
| Professional | | $851.14 | $1,258.93 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $2,884.03 / $8,128.31
| Facility | | $323.59 | $2,884.03 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,445.44 / $3,090.30
| Professional | | $912.01 | $1,445.44 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,174.90 / $2,137.96
| Professional | | $831.76 | $1,174.90 | $2,137.96 |