- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,584.89 / $8,511.38
| Facility | | $1,445.44 | $1,584.89 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,778.28 / $3,311.31
| Professional | | $1,445.44 | $1,778.28 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,548.13 / $4,168.69
| Professional | | $3,019.95 | $3,548.13 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,951.21 / $4,466.84
| Professional | | $1,698.24 | $2,951.21 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,187.76 / $3,467.37
| Facility | | $1,584.89 | $2,187.76 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,570.40 / $11,748.98
| Professional | | $1,479.11 | $2,570.40 | $11,748.98 |
- 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 / $2,238.72 / $3,467.37
| Professional | | $1,445.44 | $2,238.72 | $3,467.37 |