- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $5,370.32 / $8,511.38
| Facility | | $1,548.82 | $5,370.32 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,230.27 / $1,479.11
| Professional | | $851.14 | $1,230.27 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $4,466.84 / $7,413.10
| Facility | | $1,949.84 | $4,466.84 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $1,548.82
| Professional | | $645.65 | $645.65 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,000.00 / $4,677.35
| Facility | | $812.83 | $1,000.00 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $2,238.72
| Professional | | $1,862.09 | $1,862.09 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,187.76
| Professional | | $2,137.96 | $2,137.96 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,548.82 / $1,548.82
| Professional | | $1,071.52 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $912.01
| Professional | | $645.65 | $645.65 | $912.01 |