- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,029.46 / $2,044.22 / $5,331.00
| Facility | | $1,029.46 | $2,044.22 | $5,331.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $888.50 / $1,108.95 / $1,135.68
| Professional | | $888.50 | $1,108.95 | $1,135.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.81 / $3,086.83 / $4,889.97
| Facility | | $812.81 | $3,086.83 | $4,889.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.87 / $1,125.63 / $5,452.28
| Professional | | $773.87 | $1,125.63 | $5,452.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $733.44 / $2,084.30 / $3,734.38
| Facility | | $733.44 | $2,084.30 | $3,734.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.18 / $1,336.09 / $2,543.63
| Facility | | $895.18 | $1,336.09 | $2,543.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.16 / $561.16 / $6,653.73
| Professional | | $561.16 | $561.16 | $6,653.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.16 / $561.16 / $801.65
| Professional | | $561.16 | $561.16 | $801.65 |