- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,122.02 / $8,511.38
| Facility | | $1,096.48 | $1,122.02 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,096.48 / $2,818.38
| Professional | | $1,000.00 | $1,096.48 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,454.71 / $2,951.21
| Professional | | $1,995.26 | $2,454.71 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,089.30 / $3,467.37
| Professional | | $1,258.93 | $2,089.30 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,380.38 / $2,089.30
| Facility | | $1,122.02 | $1,380.38 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,949.84 / $8,317.64
| Professional | | $1,174.90 | $1,949.84 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,041.74 / $24,547.09
| Facility | | $1,819.70 | $2,041.74 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,949.84 / $2,691.53
| Professional | | $1,174.90 | $1,949.84 | $2,691.53 |