- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.66 / $1,943.21 / $4,434.60
| Facility | | $1,277.66 | $1,943.21 | $4,434.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,029.90 / $1,277.66 / $1,360.25
| Professional | | $1,029.90 | $1,277.66 | $1,360.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,242.10 / $2,851.66 / $4,809.43
| Facility | | $1,242.10 | $2,851.66 | $4,809.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $991.03 / $2,489.44 / $3,317.30
| Professional | | $991.03 | $2,489.44 | $3,317.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,263.08 / $6,250.11 / $11,154.15
| Facility | | $1,263.08 | $6,250.11 | $11,154.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,234.69 / $3,540.53 / $4,799.72
| Professional | | $2,234.69 | $3,540.53 | $4,799.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $893.88 / $1,165.93 / $3,410.14
| Professional | | $893.88 | $1,165.93 | $3,410.14 |