- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.91 / $7,340.00 / $13,413.92
| Facility | | $1,400.91 | $7,340.00 | $13,413.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.10 / $1,457.06 / $2,363.63
| Professional | | $750.10 | $1,457.06 | $2,363.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.86 / $803.85 / $1,526.64
| Professional | | $522.86 | $803.85 | $1,526.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,457.06 / $2,083.60 / $3,309.08
| Facility | | $1,457.06 | $2,083.60 | $3,309.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $735.08 / $882.09 / $1,456.56
| Professional | | $735.08 | $882.09 | $1,456.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $728.53 / $1,300.50 / $2,098.40
| Professional | | $728.53 | $1,300.50 | $2,098.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,457.06 / $2,083.60 / $3,309.08
| Facility | | $1,457.06 | $2,083.60 | $3,309.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.74 / $1,138.80 / $2,088.00
| Professional | | $543.74 | $1,138.80 | $2,088.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.91 / $1,221.32 / $1,842.49
| Professional | | $509.91 | $1,221.32 | $1,842.49 |