- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,005.41 / $2,513.52 / $10,850.80
| Facility | | $1,005.41 | $2,513.52 | $10,850.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,005.41 / $1,479.66 / $1,612.45
| Professional | | $1,005.41 | $1,479.66 | $1,612.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,854.32 / $4,181.04 / $8,692.71
| Facility | | $1,854.32 | $4,181.04 | $8,692.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,991.85 / $2,485.07 / $3,456.33
| Professional | | $1,991.85 | $2,485.07 | $3,456.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.19 / $1,327.90 / $8,702.00
| Facility | | $355.19 | $1,327.90 | $8,702.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.74 / $1,138.20 / $1,944.43
| Professional | | $796.74 | $1,138.20 | $1,944.43 |