- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,249.38 / $1,805.19 / $4,336.45
| Facility | | $1,249.38 | $1,805.19 | $4,336.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,007.11 / $1,249.38 / $1,330.14
| Professional | | $1,007.11 | $1,249.38 | $1,330.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.79 / $2,788.54 / $4,703.00
| Facility | | $540.79 | $2,788.54 | $4,703.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $599.54 / $779.03 / $1,254.13
| Professional | | $599.54 | $779.03 | $1,254.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,235.13 / $5,268.64 / $10,906.11
| Facility | | $1,235.13 | $5,268.64 | $10,906.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,330.14 / $2,988.06 / $4,693.49
| Professional | | $1,330.14 | $2,988.06 | $4,693.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.08 / $1,140.11 / $3,334.66
| Professional | | $798.08 | $1,140.11 | $3,334.66 |