- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $3,630.78 / $9,549.93
| Facility | | $912.01 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $741.31 / $933.25
| Professional | | $630.96 | $741.31 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,148.15 / $1,698.24
| Professional | | $891.25 | $1,148.15 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,000.00 / $1,548.82
| Facility | | $707.95 | $1,000.00 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $977.24 / $7,413.10
| Facility | | $575.44 | $977.24 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,290.87 / $4,786.30
| Facility | | $1,122.02 | $2,290.87 | $4,786.30 |