- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,584.89 / $8,511.38
| Facility | | $1,479.11 | $1,584.89 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,737.80 / $3,311.31
| Professional | | $1,479.11 | $1,737.80 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,630.78 / $4,265.80
| Professional | | $3,019.95 | $3,630.78 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,951.21 / $4,570.88
| Professional | | $1,737.80 | $2,951.21 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,238.72 / $3,388.44
| Facility | | $1,548.82 | $2,238.72 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,570.40 / $13,182.57
| Professional | | $1,479.11 | $2,570.40 | $13,182.57 |
- 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
- $1,445.44 / $2,187.76 / $3,467.37
| Professional | | $1,445.44 | $2,187.76 | $3,467.37 |