- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,090.30 / $8,128.31
| Facility | | $1,412.54 | $3,090.30 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,621.81 / $2,951.21
| Professional | | $1,202.26 | $1,621.81 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,570.40 / $9,120.11
| Facility | | $1,995.26 | $2,570.40 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,071.52 / $3,981.07
| Professional | | $794.33 | $1,071.52 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $3,715.35 / $8,128.31
| Facility | | $630.96 | $3,715.35 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,454.71 / $4,897.79
| Professional | | $1,000.00 | $2,454.71 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,995.26 / $2,398.83
| Facility | | $1,202.26 | $1,995.26 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,202.26 / $2,398.83
| Professional | | $831.76 | $1,202.26 | $2,398.83 |