- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,384.17 / $2,239.09 / $6,061.05
| Facility | | $1,384.17 | $2,239.09 | $6,061.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,010.17 / $1,139.30 / $1,291.20
| Professional | | $1,010.17 | $1,139.30 | $1,291.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,046.90 / $3,975.80 / $6,298.23
| Facility | | $1,046.90 | $3,975.80 | $6,298.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $996.73 / $1,449.79 / $7,022.43
| Professional | | $996.73 | $1,449.79 | $7,022.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,004.67 / $2,468.48 / $4,443.26
| Facility | | $1,004.67 | $2,468.48 | $4,443.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.77 / $1,519.06 / $2,796.70
| Facility | | $1,017.77 | $1,519.06 | $2,796.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.01 / $638.01 / $7,564.92
| Professional | | $638.01 | $638.01 | $7,564.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.01 / $638.01 / $911.44
| Professional | | $638.01 | $638.01 | $911.44 |