- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.15 / $2,333.00 / $7,250.02
| Facility | | $1,071.15 | $2,333.00 | $7,250.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $769.26 / $2,822.80 / $4,974.33
| Professional | | $769.26 | $2,822.80 | $4,974.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,430.62 / $5,430.62 / $6,516.74
| Facility | | $5,430.62 | $5,430.62 | $6,516.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.27 / $1,244.51 / $5,605.35
| Professional | | $846.27 | $1,244.51 | $5,605.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,337.37 / $4,337.37 / $4,337.37
| Facility | | $4,337.37 | $4,337.37 | $4,337.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,133.89 / $1,513.10 / $6,708.23
| Professional | | $1,133.89 | $1,513.10 | $6,708.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,565.00 / $2,828.00 / $6,957.00
| Facility | | $1,565.00 | $2,828.00 | $6,957.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,381.73 / $4,021.64 / $7,381.82
| Professional | | $2,381.73 | $4,021.64 | $7,381.82 |