- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,137.96 / $7,762.47
| Facility | | $1,023.29 | $2,137.96 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,023.29 / $2,630.27
| Professional | | $977.24 | $1,023.29 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,202.26 / $1,479.11
| Professional | | $1,096.48 | $1,202.26 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,318.26 / $2,630.27
| Professional | | $933.25 | $1,318.26 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,089.30 / $2,290.87
| Professional | | $1,047.13 | $2,089.30 | $2,290.87 |
- 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
- $870.96 / $1,288.25 / $2,570.40
| Professional | | $870.96 | $1,288.25 | $2,570.40 |