- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,467.37 / $6,760.83
| Facility | | $1,202.26 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,659.59 / $3,311.31
| Professional | | $1,513.56 | $1,659.59 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,137.96 / $2,511.89
| Professional | | $1,698.24 | $2,137.96 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,570.40 / $7,079.46
| Facility | | $1,230.27 | $2,570.40 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,949.84 / $12,882.50
| Professional | | $1,513.56 | $1,949.84 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,073.80 / $8,317.64
| Facility | | $1,230.27 | $4,073.80 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,778.28 / $2,511.89
| Professional | | $1,412.54 | $1,778.28 | $2,511.89 |