- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,003.13 / $3,240.37 / $8,771.42
| Facility | | $2,003.13 | $3,240.37 | $8,771.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,461.90 / $1,824.63 / $1,868.60
| Professional | | $1,461.90 | $1,824.63 | $1,868.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,140.84 / $4,332.60 / $6,863.45
| Facility | | $1,140.84 | $4,332.60 | $6,863.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,442.45 / $2,098.10 / $10,162.69
| Professional | | $1,442.45 | $2,098.10 | $10,162.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,468.48 / $3,572.33 / $6,430.19
| Facility | | $1,468.48 | $3,572.33 | $6,430.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,472.89 / $2,198.35 / $4,046.62
| Facility | | $1,472.89 | $2,198.35 | $4,046.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $923.31 / $923.31 / $10,947.78
| Professional | | $923.31 | $923.31 | $10,947.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $923.31 / $923.31 / $1,319.01
| Professional | | $923.31 | $923.31 | $1,319.01 |