- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,230.27 / $8,511.38
| Facility | | $1,148.15 | $1,230.27 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,380.38 / $2,691.53
| Professional | | $1,122.02 | $1,380.38 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,754.23 / $3,311.31
| Professional | | $2,344.23 | $2,754.23 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,290.87 / $3,467.37
| Professional | | $1,318.26 | $2,290.87 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,737.80 / $2,630.27
| Facility | | $1,230.27 | $1,737.80 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,905.46 / $9,120.11
| Professional | | $1,122.02 | $1,905.46 | $9,120.11 |
- 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
- $1,122.02 / $1,698.24 / $2,754.23
| Professional | | $1,122.02 | $1,698.24 | $2,754.23 |