- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,026.16 / $3,443.12 / $8,074.63
| Facility | | $1,026.16 | $3,443.12 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.84 / $1,035.33 / $1,659.90
| Professional | | $887.84 | $1,035.33 | $1,659.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,399.48 / $4,699.53 / $8,187.38
| Facility | | $2,399.48 | $4,699.53 | $8,187.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $934.57 / $1,297.71 / $2,006.16
| Professional | | $934.57 | $1,297.71 | $2,006.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,139.66 / $1,139.66 / $1,598.96
| Facility | | $1,139.66 | $1,139.66 | $1,598.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $999.11 / $1,444.13 / $2,244.48
| Professional | | $999.11 | $1,444.13 | $2,244.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.84 / $1,337.18 / $2,382.77
| Professional | | $977.84 | $1,337.18 | $2,382.77 |