- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,570.88 / $8,511.38
| Facility | | $2,290.87 | $4,570.88 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $645.65 / $1,862.09
| Professional | | $398.11 | $645.65 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,365.16 / $10,964.78
| Facility | | $3,715.35 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $891.25 / $1,202.26
| Professional | | $524.81 | $891.25 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $3,548.13
| Facility | | $851.14 | $851.14 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,000.00 / $4,073.80
| Professional | | $616.60 | $1,000.00 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,202.26 / $3,801.89
| Professional | | $575.44 | $1,202.26 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $5,495.41 / $9,332.54
| Facility | | $2,630.27 | $5,495.41 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $891.25 / $2,398.83
| Professional | | $457.09 | $891.25 | $2,398.83 |