- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,646.37 / $2,408.21 / $2,950.60
| Facility | | $1,646.37 | $2,408.21 | $2,950.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $991.03 / $1,143.91 / $1,646.37
| Professional | | $991.03 | $1,143.91 | $1,646.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,025.30 / $1,467.00 / $2,929.19
| Professional | | $1,025.30 | $1,467.00 | $2,929.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,004.61 / $1,863.70 / $3,757.49
| Facility | | $1,004.61 | $1,863.70 | $3,757.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,257.26 / $2,068.98 / $3,622.34
| Professional | | $1,257.26 | $2,068.98 | $3,622.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $971.77 / $1,892.40 / $3,212.12
| Professional | | $971.77 | $1,892.40 | $3,212.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.40 / $1,545.94 / $2,965.36
| Professional | | $954.40 | $1,545.94 | $2,965.36 |