- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,174.90 / $8,511.38
| Facility | | $1,122.02 | $1,174.90 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,174.90 / $2,884.03
| Professional | | $977.24 | $1,174.90 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,570.40 / $3,019.95
| Professional | | $2,089.30 | $2,570.40 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,187.76 / $3,548.13
| Professional | | $1,318.26 | $2,187.76 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,445.44 / $3,467.37
| Facility | | $1,174.90 | $1,445.44 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,089.30 / $8,709.64
| Professional | | $1,148.15 | $2,089.30 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,370.32 / $5,888.44
| Facility | | $3,801.89 | $5,370.32 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,089.30 / $2,818.38
| Professional | | $1,148.15 | $2,089.30 | $2,818.38 |