- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,096.48 / $8,511.38
| Facility | | $1,071.52 | $1,096.48 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,122.02 / $2,630.27
| Professional | | $933.25 | $1,122.02 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,454.71 / $2,884.03
| Professional | | $1,995.26 | $2,454.71 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,089.30 / $3,388.44
| Professional | | $1,174.90 | $2,089.30 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,412.54 / $3,311.31
| Facility | | $1,096.48 | $1,412.54 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,041.74 / $8,128.31
| Professional | | $1,071.52 | $2,041.74 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,888.44 / $6,606.93
| Facility | | $5,370.32 | $5,888.44 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,995.26 / $2,691.53
| Professional | | $1,071.52 | $1,995.26 | $2,691.53 |