- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,332.78 / $3,880.84 / $9,890.76
| Facility | | $1,332.78 | $3,880.84 | $9,890.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,045.71 / $1,189.44 / $1,332.78
| Professional | | $1,045.71 | $1,189.44 | $1,332.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,367.02 / $1,842.47 / $2,524.12
| Professional | | $1,367.02 | $1,842.47 | $2,524.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $45.00 / $80.00
| Professional | | $30.00 | $45.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,521.98 / $1,982.40 / $2,888.92
| Facility | | $1,521.98 | $1,982.40 | $2,888.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,292.66 / $1,638.77 / $2,049.37
| Professional | | $1,292.66 | $1,638.77 | $2,049.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.08 / $1,429.01 / $1,976.41
| Professional | | $1,054.08 | $1,429.01 | $1,976.41 |