- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.27 / $1,030.89 / $5,128.12
| Facility | | $1,000.27 | $1,030.89 | $5,128.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.27 / $1,155.27 / $1,481.07
| Professional | | $1,000.27 | $1,155.27 | $1,481.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $743.43 / $1,267.70 / $2,447.21
| Professional | | $743.43 | $1,267.70 | $2,447.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $836.42 / $836.42 / $901.10
| Facility | | $836.42 | $836.42 | $901.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,079.91 / $1,426.36 / $3,447.26
| Professional | | $1,079.91 | $1,426.36 | $3,447.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,455.17 / $6,135.96 / $6,135.96
| Facility | | $2,455.17 | $6,135.96 | $6,135.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,248.35 / $7,248.35 / $9,898.58
| Professional | | $7,248.35 | $7,248.35 | $9,898.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $697.02 / $1,077.85 / $1,758.15
| Professional | | $697.02 | $1,077.85 | $1,758.15 |