- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,570.40 / $11,481.54
| Facility | | $1,047.13 | $2,570.40 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,479.11 / $3,090.30
| Professional | | $1,288.25 | $1,479.11 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,548.13 / $10,471.29
| Facility | | $3,162.28 | $3,548.13 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,737.80
| Professional | | $1,174.90 | $1,174.90 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,606.93 / $9,332.54
| Facility | | $2,951.21 | $6,606.93 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $2,454.71 / $7,585.78
| Professional | | $954.99 | $2,454.71 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $3,467.37
| Professional | | $1,819.70 | $1,819.70 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,479.11 / $4,897.79
| Professional | | $1,096.48 | $1,479.11 | $4,897.79 |