- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,058.38 / $1,397.00 / $4,478.00
| Facility | | $1,058.38 | $1,397.00 | $4,478.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.01 / $1,078.43 / $1,251.50
| Professional | | $855.01 | $1,078.43 | $1,251.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,027.36 / $3,027.36 / $3,632.83
| Facility | | $3,027.36 | $3,027.36 | $3,632.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,018.21 / $1,272.76 / $1,347.63
| Professional | | $1,018.21 | $1,272.76 | $1,347.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.00 / $2,268.00 / $5,626.00
| Facility | | $1,240.00 | $2,268.00 | $5,626.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $853.08 / $1,157.91 / $1,739.75
| Professional | | $853.08 | $1,157.91 | $1,739.75 |