- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,122.02 / $8,511.38
| Facility | | $1,096.48 | $1,122.02 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,096.48 / $2,754.23
| Professional | | $741.31 | $1,096.48 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,630.27 / $3,162.28
| Professional | | $2,137.96 | $2,630.27 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,137.96 / $3,467.37
| Professional | | $1,023.29 | $2,137.96 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,479.11 / $3,388.44
| Facility | | $1,071.52 | $1,479.11 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,584.89 / $9,549.93
| Professional | | $1,047.13 | $1,584.89 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,677.35 / $5,128.61
| Facility | | $3,801.89 | $4,677.35 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,737.80 / $2,818.38
| Professional | | $954.99 | $1,737.80 | $2,818.38 |