- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,148.15 / $8,511.38
| Facility | | $1,071.52 | $1,148.15 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,288.25 / $2,398.83
| Professional | | $1,047.13 | $1,288.25 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,570.40 / $3,090.30
| Professional | | $2,187.76 | $2,570.40 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,137.96 / $3,235.94
| Professional | | $1,258.93 | $2,137.96 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,584.89 / $2,511.89
| Facility | | $1,148.15 | $1,584.89 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,862.09 / $8,709.64
| Professional | | $1,071.52 | $1,862.09 | $8,709.64 |
- 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
- $1,047.13 / $1,621.81 / $2,570.40
| Professional | | $1,047.13 | $1,621.81 | $2,570.40 |