- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,715.35 / $9,549.93
| Facility | | $1,047.13 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $831.76 / $2,041.74
| Professional | | $691.83 | $831.76 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,623.41 / $13,489.63
| Facility | | $1,862.09 | $5,623.41 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $977.24 / $1,905.46
| Professional | | $676.08 | $977.24 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,698.24 / $6,025.60
| Facility | | $870.96 | $1,698.24 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,122.02 / $2,570.40
| Professional | | $758.58 | $1,122.02 | $2,570.40 |
- 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
- $630.96 / $891.25 / $1,698.24
| Professional | | $630.96 | $891.25 | $1,698.24 |