- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,202.26 / $8,511.38
| Facility | | $1,148.15 | $1,202.26 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,202.26 / $2,290.87
| Professional | | $1,071.52 | $1,202.26 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,454.71 / $2,884.03
| Professional | | $1,949.84 | $2,454.71 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,089.30 / $3,548.13
| Professional | | $1,148.15 | $2,089.30 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,949.84 / $3,467.37
| Facility | | $1,148.15 | $1,949.84 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,862.09 / $3,019.95
| Professional | | $1,122.02 | $1,862.09 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,754.40 / $8,912.51
| Facility | | $4,677.35 | $5,754.40 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,862.09 / $2,691.53
| Professional | | $1,122.02 | $1,862.09 | $2,691.53 |