- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,055.76 / $9,577.00 / $14,552.94
| Facility | | $2,055.76 | $9,577.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.47 / $2,932.74 / $3,948.51
| Professional | | $518.47 | $2,932.74 | $3,948.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.16 / $667.16 / $2,313.59
| Professional | | $667.16 | $667.16 | $2,313.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $653.91 / $887.45 / $5,646.37
| Facility | | $653.91 | $887.45 | $5,646.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,300.33 / $1,827.13 / $3,702.25
| Professional | | $1,300.33 | $1,827.13 | $3,702.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,916.25 / $2,746.25 / $3,729.80
| Professional | | $1,916.25 | $2,746.25 | $3,729.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.84 / $1,110.63 / $5,646.37
| Facility | | $796.84 | $1,110.63 | $5,646.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $692.27 / $2,654.40 / $3,823.95
| Professional | | $692.27 | $2,654.40 | $3,823.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $857.46 / $1,850.86 / $5,604.70
| Professional | | $857.46 | $1,850.86 | $5,604.70 |