- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,123.57 / $3,650.50 / $8,074.63
| Facility | | $1,123.57 | $3,650.50 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $960.50 / $1,157.76 / $1,631.66
| Professional | | $960.50 | $1,157.76 | $1,631.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,769.10 / $8,883.46 / $15,216.00
| Facility | | $4,769.10 | $8,883.46 | $15,216.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $964.83 / $1,358.62 / $1,990.23
| Professional | | $964.83 | $1,358.62 | $1,990.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,117.19 / $1,117.19 / $2,956.96
| Facility | | $1,117.19 | $1,117.19 | $2,956.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,083.28 / $1,473.85 / $2,483.48
| Professional | | $1,083.28 | $1,473.85 | $2,483.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,152.00
| Facility | | $1,403.00 | $3,325.00 | $8,152.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,025.57 / $1,520.04 / $2,419.46
| Professional | | $1,025.57 | $1,520.04 | $2,419.46 |