- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,818.38 / $9,772.37
| Facility | | $851.14 | $2,818.38 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,122.02 / $1,778.28
| Professional | | $1,000.00 | $1,122.02 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,073.80 / $9,549.93
| Facility | | $2,630.27 | $4,073.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,148.15 / $1,621.81
| Professional | | $977.24 | $1,148.15 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,819.70 / $2,290.87
| Facility | | $1,380.38 | $1,819.70 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,819.70 / $6,606.93
| Professional | | $1,071.52 | $1,819.70 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,754.23 / $6,309.57
| Facility | | $602.56 | $2,754.23 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,380.38 / $1,995.26
| Professional | | $933.25 | $1,380.38 | $1,995.26 |