- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,026.14 / $2,842.41 / $4,968.70
| Facility | | $1,026.14 | $2,842.41 | $4,968.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $728.00 / $1,039.65 / $1,282.68
| Professional | | $728.00 | $1,039.65 | $1,282.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,427.15 / $3,888.55 / $6,183.87
| Facility | | $1,427.15 | $3,888.55 | $6,183.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.07 / $567.07 / $1,350.19
| Professional | | $567.07 | $567.07 | $1,350.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.86 / $1,184.79 / $3,475.38
| Facility | | $789.86 | $1,184.79 | $3,475.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $627.60 / $992.30 / $1,958.00
| Professional | | $627.60 | $992.30 | $1,958.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,026.14 / $1,350.19 / $1,890.27
| Facility | | $1,026.14 | $1,350.19 | $1,890.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,012.64 / $1,890.27 / $3,353.00
| Professional | | $1,012.64 | $1,890.27 | $3,353.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.08 / $567.08 / $999.14
| Professional | | $567.08 | $567.08 | $999.14 |