- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,715.35 / $6,760.83
| Facility | | $1,737.80 | $3,715.35 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,000.00 / $2,818.38
| Professional | | $812.83 | $1,000.00 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,778.28 / $2,691.53
| Facility | | $549.54 | $1,778.28 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,174.90 / $2,187.76
| Professional | | $1,000.00 | $1,174.90 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,096.48 / $1,905.46
| Professional | | $812.83 | $1,096.48 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,288.25 / $7,943.28
| Facility | | $870.96 | $1,288.25 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,122.02 / $7,079.46
| Professional | | $794.33 | $1,122.02 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $6,025.60 / $8,709.64
| Facility | | $4,466.84 | $6,025.60 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $977.24 / $1,737.80
| Professional | | $776.25 | $977.24 | $1,737.80 |