- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.79 / $1,084.84 / $4,846.00
| Facility | | $1,000.79 | $1,084.84 | $4,846.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $915.09 / $1,045.85 / $1,349.50
| Professional | | $915.09 | $1,045.85 | $1,349.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,091.00 / $10,577.42 / $18,643.75
| Facility | | $5,091.00 | $10,577.42 | $18,643.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,088.92 / $1,389.60 / $1,917.64
| Professional | | $1,088.92 | $1,389.60 | $1,917.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $864.50 / $1,139.10 / $1,830.72
| Facility | | $864.50 | $1,139.10 | $1,830.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $854.33 / $1,057.75 / $1,464.57
| Professional | | $854.33 | $1,057.75 | $1,464.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $927.78 / $1,391.81 / $3,087.50
| Professional | | $927.78 | $1,391.81 | $3,087.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $5,242.00 / $10,843.00
| Facility | | $1,403.00 | $5,242.00 | $10,843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $884.50 / $1,227.77 / $1,839.76
| Professional | | $884.50 | $1,227.77 | $1,839.76 |