- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,319.01 / $1,648.76 / $9,518.86
| Facility | | $1,319.01 | $1,648.76 | $9,518.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,198.09 / $1,494.88 / $1,978.52
| Professional | | $1,198.09 | $1,494.88 | $1,978.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,104.44 / $1,546.22 / $8,265.48
| Facility | | $1,104.44 | $1,546.22 | $8,265.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,677.46 / $2,677.46 / $3,207.90
| Professional | | $2,677.46 | $2,677.46 | $3,207.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,319.01 / $1,319.01 / $1,868.60
| Professional | | $1,319.01 | $1,319.01 | $1,868.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,978.52 / $1,978.52 / $3,297.52
| Facility | | $1,978.52 | $1,978.52 | $3,297.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $769.42 / $923.31 / $3,444.51
| Professional | | $769.42 | $923.31 | $3,444.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,319.01 / $1,319.01 / $1,319.01
| Professional | | $1,319.01 | $1,319.01 | $1,319.01 |