- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $960.87 / $3,392.50 / $8,074.63
| Facility | | $960.87 | $3,392.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $757.55 / $913.46 / $1,370.38
| Professional | | $757.55 | $913.46 | $1,370.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,912.18 / $8,269.50 / $13,207.86
| Facility | | $3,912.18 | $8,269.50 | $13,207.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $810.49 / $1,077.95 / $1,631.87
| Professional | | $810.49 | $1,077.95 | $1,631.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $923.74 / $923.74 / $1,280.32
| Facility | | $923.74 | $923.74 | $1,280.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.18 / $1,219.83 / $1,923.05
| Professional | | $838.18 | $1,219.83 | $1,923.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.28 / $1,128.10 / $1,938.79
| Professional | | $797.28 | $1,128.10 | $1,938.79 |