- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $2,884.03 / $10,715.19
| Facility | | $870.96 | $2,884.03 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,454.71 / $3,467.37
| Professional | | $1,737.80 | $2,454.71 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $4,365.16 / $10,964.78
| Facility | | $776.25 | $4,365.16 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,000.00 / $3,981.07
| Professional | | $549.54 | $1,000.00 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,318.26 / $7,079.46
| Facility | | $380.19 | $1,318.26 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $645.65 / $1,348.96
| Professional | | $363.08 | $645.65 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $3,090.30 / $8,912.51
| Facility | | $467.74 | $3,090.30 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $1,621.81 / $3,630.78
| Professional | | $524.81 | $1,621.81 | $3,630.78 |