- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.91 / $4,126.18 / $7,010.50
| Facility | | $884.91 | $4,126.18 | $7,010.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,003.00 / $2,003.00 / $2,292.39
| Professional | | $2,003.00 | $2,003.00 | $2,292.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,651.72 / $1,651.72 / $1,651.72
| Facility | | $1,651.72 | $1,651.72 | $1,651.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $686.82 / $686.82 / $858.52
| Professional | | $686.82 | $686.82 | $858.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $585.25 / $585.25 / $719.07
| Facility | | $585.25 | $585.25 | $719.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.91 / $597.91 / $2,391.64
| Professional | | $597.91 | $597.91 | $2,391.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,092.69 / $2,212.27 / $2,391.64
| Facility | | $2,092.69 | $2,212.27 | $2,391.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.12 / $903.15 / $2,391.64
| Professional | | $538.12 | $903.15 | $2,391.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $585.25 / $585.25 / $719.07
| Facility | | $585.25 | $585.25 | $719.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $568.01 / $609.87 / $1,644.25
| Professional | | $568.01 | $609.87 | $1,644.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.00 / $1,195.82 / $1,804.02
| Professional | | $42.00 | $1,195.82 | $1,804.02 |