- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,137.96 / $7,762.47
| Facility | | $1,047.13 | $2,137.96 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,047.13 / $2,570.40
| Professional | | $954.99 | $1,047.13 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,122.02 / $1,348.96
| Professional | | $1,023.29 | $1,122.02 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,230.27 / $2,630.27
| Professional | | $933.25 | $1,230.27 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,041.74 / $2,290.87
| Professional | | $1,071.52 | $2,041.74 | $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
- $758.58 / $1,230.27 / $2,754.23
| Professional | | $758.58 | $1,230.27 | $2,754.23 |