- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,165.93 / $1,457.41 / $8,414.10
| Facility | | $1,165.93 | $1,457.41 | $8,414.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,059.05 / $1,321.38 / $1,748.89
| Professional | | $1,059.05 | $1,321.38 | $1,748.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $959.16 / $1,342.82 / $7,306.04
| Facility | | $959.16 | $1,342.82 | $7,306.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,366.64 / $2,366.64 / $2,835.50
| Professional | | $2,366.64 | $2,366.64 | $2,835.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,165.93 / $1,165.93 / $1,651.73
| Professional | | $1,165.93 | $1,165.93 | $1,651.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $70.00
| Professional | | $50.00 | $50.00 | $70.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,943.21 / $1,943.21 / $2,914.82
| Facility | | $1,943.21 | $1,943.21 | $2,914.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $680.12 / $816.15 / $2,615.56
| Professional | | $680.12 | $816.15 | $2,615.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,165.93 / $1,165.93 / $1,165.93
| Professional | | $1,165.93 | $1,165.93 | $1,165.93 |