- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,862.09 / $8,511.38
| Facility | | $1,096.48 | $1,862.09 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,570.40 / $2,951.21
| Professional | | $1,096.48 | $2,570.40 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,466.84 / $5,370.32
| Professional | | $3,801.89 | $4,466.84 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,754.23
| Professional | | $2,238.72 | $2,238.72 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,398.83 / $3,467.37
| Facility | | $1,096.48 | $2,398.83 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,513.56 / $3,715.35
| Professional | | $630.96 | $1,513.56 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,041.74 / $14,125.38
| Facility | | $1,819.70 | $2,041.74 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,778.28 / $3,388.44
| Professional | | $575.44 | $1,778.28 | $3,388.44 |