- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,691.53 / $6,760.83
| Facility | | $933.25 | $2,691.53 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,000.00 / $1,737.80
| Professional | | $831.76 | $1,000.00 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $8,709.64 / $12,302.69
| Facility | | $4,466.84 | $8,709.64 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,230.27 / $1,479.11
| Professional | | $1,071.52 | $1,230.27 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $812.83 / $2,818.38
| Facility | | $39.81 | $812.83 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,288.25 / $4,265.80
| Facility | | $724.44 | $1,288.25 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,148.15 / $1,905.46
| Professional | | $660.69 | $1,148.15 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,677.35 / $11,748.98
| Facility | | $1,096.48 | $4,677.35 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,000.00 / $1,659.59
| Professional | | $724.44 | $1,000.00 | $1,659.59 |