- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.00 / $1,399.36 / $4,478.00
| Facility | | $1,083.00 | $1,399.36 | $4,478.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.40 / $1,296.48 / $1,698.21
| Professional | | $943.40 | $1,296.48 | $1,698.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,555.03 / $3,555.03 / $4,266.04
| Facility | | $3,555.03 | $3,555.03 | $4,266.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,297.61 / $1,717.44 / $1,908.27
| Professional | | $1,297.61 | $1,717.44 | $1,908.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,708.38 / $2,708.38 / $2,708.38
| Facility | | $2,708.38 | $2,708.38 | $2,708.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.60 / $1,440.00 / $2,084.76
| Professional | | $900.60 | $1,440.00 | $2,084.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.00 / $2,311.00 / $5,626.00
| Facility | | $1,240.00 | $2,311.00 | $5,626.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $962.87 / $1,203.58 / $2,149.48
| Professional | | $962.87 | $1,203.58 | $2,149.48 |