- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,137.96 / $7,762.47
| Facility | | $1,659.59 | $2,137.96 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,584.89 / $2,344.23
| Professional | | $1,348.96 | $1,584.89 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,548.82 / $2,041.74
| Professional | | $1,122.02 | $1,548.82 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,621.81 / $4,073.80
| Professional | | $1,230.27 | $1,621.81 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,513.56 / $3,019.95
| Professional | | $1,445.44 | $1,513.56 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,290.87 / $6,309.57
| Facility | | $645.65 | $2,290.87 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,584.89 / $3,548.13
| Professional | | $1,174.90 | $1,584.89 | $3,548.13 |