- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,477.48 / $1,641.22 / $2,461.83
| Facility | | $1,477.48 | $1,641.22 | $2,461.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,140.53 / $1,641.22 / $2,016.56
| Professional | | $1,140.53 | $1,641.22 | $2,016.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,967.24 / $2,603.69 / $2,603.69
| Professional | | $1,967.24 | $2,603.69 | $2,603.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,537.52 / $2,408.87 / $2,983.00
| Professional | | $1,537.52 | $2,408.87 | $2,983.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,104.00 / $4,555.00 / $8,929.00
| Facility | | $2,104.00 | $4,555.00 | $8,929.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $880.44 / $1,436.37 / $2,681.62
| Professional | | $880.44 | $1,436.37 | $2,681.62 |