- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,086.73 / $3,304.30 / $7,879.32
| Facility | | $1,086.73 | $3,304.30 | $7,879.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $911.25 / $1,066.66 / $1,549.52
| Professional | | $911.25 | $1,066.66 | $1,549.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,794.00 / $8,672.74 / $13,917.11
| Facility | | $3,794.00 | $8,672.74 | $13,917.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.38 / $1,197.16 / $2,049.04
| Professional | | $920.38 | $1,197.16 | $2,049.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $1,159.75
| Facility | | $680.00 | $870.49 | $1,159.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $942.90 / $1,400.34 / $2,380.48
| Professional | | $942.90 | $1,400.34 | $2,380.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.00 / $2,575.00 / $7,326.50
| Facility | | $718.00 | $2,575.00 | $7,326.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.08 / $1,240.52 / $2,252.73
| Professional | | $920.08 | $1,240.52 | $2,252.73 |