- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,288.25 / $8,511.38
| Facility | | $1,096.48 | $1,288.25 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,096.48 / $1,288.25
| Professional | | $371.54 | $1,096.48 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $5,888.44 / $7,244.36
| Professional | | $5,888.44 | $5,888.44 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,584.89 / $3,890.45
| Facility | | $1,288.25 | $1,584.89 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,137.96 / $13,489.63
| Professional | | $1,148.15 | $2,137.96 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,041.74 / $2,041.74
| Facility | | $1,819.70 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,089.30 / $14,454.40
| Professional | | $1,148.15 | $2,089.30 | $14,454.40 |