- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,960.20 / $4,019.64 / $9,348.00
| Facility | | $2,960.20 | $4,019.64 | $9,348.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.58 / $320.58 / $5,516.91
| Professional | | $320.58 | $320.58 | $5,516.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,777.29 / $4,414.17 / $8,833.86
| Facility | | $2,777.29 | $4,414.17 | $8,833.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $997.52 / $1,589.16 / $6,001.40
| Professional | | $997.52 | $1,589.16 | $6,001.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,530.50 / $3,503.11 / $12,724.99
| Facility | | $2,530.50 | $3,503.11 | $12,724.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,732.46 / $3,867.78 / $7,011.89
| Professional | | $1,732.46 | $3,867.78 | $7,011.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,622.11 / $4,150.51 / $5,266.04
| Professional | | $2,622.11 | $4,150.51 | $5,266.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,433.36 / $1,875.44 / $5,468.27
| Professional | | $1,433.36 | $1,875.44 | $5,468.27 |