- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $3,090.30 / $8,912.51
| Facility | | $676.08 | $3,090.30 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $467.74 / $1,000.00
| Professional | | $389.05 | $467.74 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,365.16 / $10,232.93
| Facility | | $1,905.46 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $549.54 / $1,096.48
| Professional | | $371.54 | $549.54 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,202.26 / $3,311.31
| Facility | | $323.59 | $1,202.26 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $630.96 / $1,445.44
| Professional | | $407.38 | $630.96 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,258.93 / $3,981.07
| Facility | | $302.00 | $1,258.93 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $501.19 / $954.99
| Professional | | $354.81 | $501.19 | $954.99 |