- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,202.26 / $8,511.38
| Facility | | $1,148.15 | $1,202.26 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,148.15 / $2,884.03
| Professional | | $1,047.13 | $1,148.15 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,570.40 / $3,090.30
| Professional | | $2,089.30 | $2,570.40 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,238.72 / $3,630.78
| Professional | | $1,412.54 | $2,238.72 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,659.59 / $3,467.37
| Facility | | $1,148.15 | $1,659.59 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,995.26 / $8,709.64
| Professional | | $1,202.26 | $1,995.26 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,128.61 / $6,309.57
| Facility | | $4,677.35 | $5,128.61 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,041.74 / $2,754.23
| Professional | | $1,202.26 | $2,041.74 | $2,754.23 |