- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,245.48 / $1,556.85 / $8,988.20
| Facility | | $1,245.48 | $1,556.85 | $8,988.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,245.48 / $1,349.27 / $1,494.58
| Professional | | $1,245.48 | $1,349.27 | $1,494.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,024.60 / $1,434.45 / $3,373.18
| Facility | | $1,024.60 | $1,434.45 | $3,373.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,075.73 / $2,385.08 / $2,981.34
| Professional | | $2,075.73 | $2,385.08 | $2,981.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,245.48 / $1,245.48 / $2,594.75
| Professional | | $1,245.48 | $1,245.48 | $2,594.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,868.22 / $2,075.80 / $3,113.70
| Facility | | $1,868.22 | $2,075.80 | $3,113.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.53 / $871.84 / $2,701.74
| Professional | | $726.53 | $871.84 | $2,701.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,075.26 / $1,245.48 / $1,245.48
| Professional | | $1,075.26 | $1,245.48 | $1,245.48 |