- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,445.44 / $7,762.47
| Facility | | $1,412.54 | $1,445.44 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $977.24 / $2,187.76
| Professional | | $870.96 | $977.24 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,380.38 / $3,235.94
| Professional | | $812.83 | $1,380.38 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $281.84
| Professional | | $32.36 | $33.11 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,348.96 / $2,041.74
| Facility | | $954.99 | $1,348.96 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,412.54 / $2,238.72
| Professional | | $933.25 | $1,412.54 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $11,220.18 / $31,622.78
| Facility | | $891.25 | $11,220.18 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,380.38 / $1,905.46
| Professional | | $1,000.00 | $1,380.38 | $1,905.46 |