- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,137.96 / $7,762.47
| Facility | | $1,621.81 | $2,137.96 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,621.81 / $3,890.45
| Professional | | $1,023.29 | $1,621.81 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,318.26 / $1,905.46
| Professional | | $1,230.27 | $1,318.26 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,737.80 / $3,311.31
| Professional | | $1,202.26 | $1,737.80 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,884.03 / $2,884.03
| Professional | | $2,691.53 | $2,884.03 | $2,884.03 |
- 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
- $1,230.27 / $1,778.28 / $3,715.35
| Professional | | $1,230.27 | $1,778.28 | $3,715.35 |