- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,367.40 / $2,165.05 / $9,868.07
| Facility | | $1,367.40 | $2,165.05 | $9,868.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,242.06 / $1,481.35 / $1,845.99
| Professional | | $1,242.06 | $1,481.35 | $1,845.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,144.58 / $1,602.42 / $8,568.71
| Facility | | $1,144.58 | $1,602.42 | $8,568.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,775.96 / $2,775.96 / $3,325.92
| Professional | | $2,775.96 | $2,775.96 | $3,325.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,367.40 / $1,367.40 / $1,937.15
| Professional | | $1,367.40 | $1,367.40 | $1,937.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,279.00 / $2,279.00 / $3,418.50
| Facility | | $2,279.00 | $2,279.00 | $3,418.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.65 / $957.18 / $3,067.53
| Professional | | $797.65 | $957.18 | $3,067.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,367.40 / $1,367.40 / $1,367.40
| Professional | | $1,367.40 | $1,367.40 | $1,367.40 |