- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,090.30 / $6,760.83
| Facility | | $1,737.80 | $3,090.30 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $891.25 / $2,398.83
| Professional | | $602.56 | $891.25 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,778.28 / $2,691.53
| Facility | | $549.54 | $1,778.28 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,202.26 / $2,238.72
| Professional | | $912.01 | $1,202.26 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $870.96 / $1,548.82
| Professional | | $549.54 | $870.96 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,000.00 / $3,162.28
| Facility | | $562.34 | $1,000.00 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,047.13 / $7,079.46
| Professional | | $602.56 | $1,047.13 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,041.74 / $4,786.30
| Facility | | $1,258.93 | $2,041.74 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $707.95 / $1,380.38
| Professional | | $512.86 | $707.95 | $1,380.38 |