- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $8,511.38
| Facility | | $1,288.25 | $3,890.45 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,047.13 / $1,778.28
| Professional | | $891.25 | $1,047.13 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,258.93 / $1,479.11
| Professional | | $954.99 | $1,258.93 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,380.38 / $7,413.10
| Facility | | $489.78 | $1,380.38 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,122.02 / $6,918.31
| Professional | | $831.76 | $1,122.02 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,949.84 / $6,165.95
| Facility | | $346.74 | $1,949.84 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,000.00 / $1,445.44
| Professional | | $776.25 | $1,000.00 | $1,445.44 |