- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,181.00 / $1,821.00 / $9,477.00
| Facility | | $1,181.00 | $1,821.00 | $9,477.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $945.91 / $1,306.68 / $1,306.68
| Professional | | $945.91 | $1,306.68 | $1,306.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,043.21 / $2,554.01 / $3,004.72
| Professional | | $2,043.21 | $2,554.01 | $3,004.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,022.63 / $1,704.45 / $2,480.00
| Professional | | $1,022.63 | $1,704.45 | $2,480.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,056.00 / $2,558.00
| Facility | | $375.00 | $1,056.00 | $2,558.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,002.62 / $1,273.33 / $2,276.91
| Professional | | $1,002.62 | $1,273.33 | $2,276.91 |