- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,202.26 / $8,511.38
| Facility | | $1,174.90 | $1,202.26 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,202.26 / $1,778.28
| Professional | | $1,096.48 | $1,202.26 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,818.38 / $3,311.31
| Professional | | $2,290.87 | $2,818.38 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,238.72 / $3,890.45
| Professional | | $1,659.59 | $2,238.72 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,778.28 / $3,630.78
| Facility | | $1,202.26 | $1,778.28 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,187.76 / $2,570.40
| Professional | | $1,122.02 | $2,187.76 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,041.74 / $2,041.74
| Facility | | $1,819.70 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,187.76 / $2,884.03
| Professional | | $1,122.02 | $2,187.76 | $2,884.03 |