- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,074.00 / $1,435.00 / $3,804.00
| Facility | | $1,074.00 | $1,435.00 | $3,804.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $907.47 / $1,052.36 / $1,504.00
| Professional | | $907.47 | $1,052.36 | $1,504.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,627.26 / $2,627.26 / $3,152.71
| Facility | | $2,627.26 | $2,627.26 | $3,152.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,062.63 / $1,328.29 / $1,406.42
| Professional | | $1,062.63 | $1,328.29 | $1,406.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,360.08 / $2,360.08 / $2,360.08
| Facility | | $2,360.08 | $2,360.08 | $2,360.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,031.02 / $1,581.71 / $1,865.58
| Professional | | $1,031.02 | $1,581.71 | $1,865.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.00 / $1,749.90 / $4,064.00
| Facility | | $980.00 | $1,749.90 | $4,064.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $934.27 / $1,358.53 / $1,891.50
| Professional | | $934.27 | $1,358.53 | $1,891.50 |