- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,010.72 / $9,577.00 / $14,552.94
| Facility | | $1,010.72 | $9,577.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,705.33 / $1,914.56 / $2,120.78
| Professional | | $1,705.33 | $1,914.56 | $2,120.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $649.59 / $841.48 / $1,466.17
| Professional | | $649.59 | $841.48 | $1,466.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,705.33 / $2,387.46 / $2,969.09
| Facility | | $1,705.33 | $2,387.46 | $2,969.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $876.60 / $1,051.92 / $1,322.64
| Professional | | $876.60 | $1,051.92 | $1,322.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $861.35 / $1,515.43 / $1,976.35
| Professional | | $861.35 | $1,515.43 | $1,976.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,705.33 / $2,387.46 / $2,969.09
| Facility | | $1,705.33 | $2,387.46 | $2,969.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.95 / $1,317.70 / $2,564.10
| Professional | | $646.95 | $1,317.70 | $2,564.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.59 / $1,172.94 / $1,769.50
| Professional | | $501.59 | $1,172.94 | $1,769.50 |