- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,461.52 / $5,511.00 / $16,900.00
| Facility | | $1,461.52 | $5,511.00 | $16,900.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,447.04 / $1,461.52 / $1,461.52
| Professional | | $1,447.04 | $1,461.52 | $1,461.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,563.82 / $1,990.28 / $2,381.98
| Professional | | $1,563.82 | $1,990.28 | $2,381.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,447.04 / $2,383.36 / $9,232.95
| Facility | | $1,447.04 | $2,383.36 | $9,232.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,404.46 / $1,914.05 / $12,853.85
| Professional | | $1,404.46 | $1,914.05 | $12,853.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.00 / $5,407.00 / $9,232.95
| Facility | | $1,481.00 | $5,407.00 | $9,232.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.43 / $1,716.56 / $2,387.58
| Professional | | $1,326.43 | $1,716.56 | $2,387.58 |