- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,096.48 / $8,511.38
| Facility | | $1,023.29 | $1,096.48 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,096.48 / $1,778.28
| Professional | | $691.83 | $1,096.48 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,290.87 / $2,691.53
| Professional | | $1,862.09 | $2,290.87 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,819.70 / $3,019.95
| Professional | | $1,445.44 | $1,819.70 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,445.44 / $3,090.30
| Facility | | $1,023.29 | $1,445.44 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,862.09 / $2,398.83
| Professional | | $1,047.13 | $1,862.09 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,041.74 / $2,041.74
| Facility | | $1,819.70 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,949.84 / $2,570.40
| Professional | | $1,047.13 | $1,949.84 | $2,570.40 |