- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,897.79 / $11,481.54
| Facility | | $1,230.27 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $891.25 / $2,137.96
| Professional | | $776.25 | $891.25 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $8,317.64 / $16,218.10
| Facility | | $2,511.89 | $8,317.64 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,047.13 / $2,089.30
| Professional | | $707.95 | $1,047.13 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,238.72 / $6,165.95
| Facility | | $630.96 | $2,238.72 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,230.27 / $2,691.53
| Professional | | $812.83 | $1,230.27 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,951.21 / $6,918.31
| Facility | | $1,000.00 | $2,951.21 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $977.24 / $1,862.09
| Professional | | $691.83 | $977.24 | $1,862.09 |