- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,278.11 / $7,340.00 / $13,413.92
| Facility | | $1,278.11 | $7,340.00 | $13,413.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.02 / $1,519.05 / $2,167.73
| Professional | | $281.02 | $1,519.05 | $2,167.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $756.06 / $1,106.65 / $1,977.00
| Professional | | $756.06 | $1,106.65 | $1,977.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.68 / $1,519.05 / $3,034.82
| Facility | | $367.68 | $1,519.05 | $3,034.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $769.05 / $1,349.82 / $2,712.45
| Professional | | $769.05 | $1,349.82 | $2,712.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,188.75 / $1,740.33 / $2,654.00
| Professional | | $1,188.75 | $1,740.33 | $2,654.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.15 / $1,670.96 / $3,034.82
| Facility | | $388.15 | $1,670.96 | $3,034.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.50 / $1,666.30 / $2,587.65
| Professional | | $655.50 | $1,666.30 | $2,587.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,173.70 / $2,011.64 / $2,582.14
| Professional | | $1,173.70 | $2,011.64 | $2,582.14 |