- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,990.72 / $6,359.35 / $13,413.92
| Facility | | $1,990.72 | $6,359.35 | $13,413.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.83 / $1,024.01 / $3,229.13
| Professional | | $209.83 | $1,024.01 | $3,229.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.16 / $563.16 / $2,220.48
| Professional | | $563.16 | $563.16 | $2,220.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.56 / $1,065.33 / $4,407.64
| Facility | | $204.56 | $1,065.33 | $4,407.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.68 / $1,335.56 / $4,552.80
| Professional | | $469.68 | $1,335.56 | $4,552.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.65 / $1,048.09 / $4,222.00
| Professional | | $646.65 | $1,048.09 | $4,222.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.56 / $1,065.33 / $4,407.64
| Facility | | $204.56 | $1,065.33 | $4,407.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.46 / $1,048.09 / $4,222.00
| Professional | | $354.46 | $1,048.09 | $4,222.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,680.44 / $1,776.38 / $3,865.01
| Professional | | $1,680.44 | $1,776.38 | $3,865.01 |