- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,288.25 / $8,511.38
| Facility | | $1,230.27 | $1,288.25 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,288.25 / $2,089.30
| Professional | | $831.76 | $1,288.25 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,754.23 / $3,235.94
| Professional | | $2,238.72 | $2,754.23 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,187.76 / $3,630.78
| Professional | | $1,737.80 | $2,187.76 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,698.24 / $3,715.35
| Facility | | $1,230.27 | $1,698.24 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,398.83 / $2,884.03
| Professional | | $1,288.25 | $2,398.83 | $2,884.03 |
- 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
- $1,288.25 / $2,344.23 / $3,090.30
| Professional | | $1,288.25 | $2,344.23 | $3,090.30 |