- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,288.25 / $8,511.38
| Facility | | $1,174.90 | $1,288.25 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,412.54 / $2,691.53
| Professional | | $1,174.90 | $1,412.54 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,884.03 / $3,388.44
| Professional | | $2,398.83 | $2,884.03 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,344.23 / $3,548.13
| Professional | | $1,548.82 | $2,344.23 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,778.28 / $2,818.38
| Facility | | $1,288.25 | $1,778.28 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,137.96 / $5,370.32
| Professional | | $1,202.26 | $2,137.96 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,819.70 / $2,041.74
| Facility | | $676.08 | $1,819.70 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,819.70 / $2,884.03
| Professional | | $1,202.26 | $1,819.70 | $2,884.03 |