- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $5,888.44 / $14,454.40
| Facility | | $1,380.38 | $5,888.44 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,000.00 / $2,290.87
| Professional | | $831.76 | $1,000.00 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $10,715.19 / $20,417.38
| Facility | | $3,715.35 | $10,715.19 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,230.27 / $2,290.87
| Professional | | $831.76 | $1,230.27 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,951.21 / $6,760.83
| Facility | | $1,479.11 | $2,951.21 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,412.54 / $3,019.95
| Professional | | $870.96 | $1,412.54 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,244.36 / $16,218.10
| Facility | | $2,511.89 | $7,244.36 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,122.02 / $2,089.30
| Professional | | $776.25 | $1,122.02 | $2,089.30 |