- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,137.96 / $7,762.47
| Facility | | $1,230.27 | $2,137.96 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,230.27 / $3,090.30
| Professional | | $776.25 | $1,230.27 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,348.96 / $1,445.44
| Professional | | $1,148.15 | $1,348.96 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,412.54 / $2,570.40
| Professional | | $912.01 | $1,412.54 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $2,187.76
| Professional | | $1,995.26 | $1,995.26 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,344.23 / $16,218.10
| Facility | | $645.65 | $2,344.23 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,445.44 / $2,818.38
| Professional | | $933.25 | $1,445.44 | $2,818.38 |