- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,023.29 / $5,888.44
| Facility | | $562.34 | $1,023.29 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $776.25 / $912.01
| Professional | | $602.56 | $776.25 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $831.76 / $1,202.26
| Professional | | $660.69 | $831.76 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $645.65 / $1,000.00
| Facility | | $478.63 | $645.65 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $602.56 / $1,479.11
| Facility | | $426.58 | $602.56 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,230.27 / $2,511.89
| Facility | | $229.09 | $1,230.27 | $2,511.89 |