- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,885.20 / $4,980.81 / $5,727.90
| Facility | | $1,885.20 | $4,980.81 | $5,727.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,073.07 / $2,073.07 / $3,479.03
| Professional | | $2,073.07 | $2,073.07 | $3,479.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.62 / $517.52 / $522.75
| Professional | | $496.62 | $517.52 | $522.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $629.63 / $787.03 / $2,202.64
| Professional | | $629.63 | $787.03 | $2,202.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,734.64 / $2,203.14 / $11,383.05
| Facility | | $1,734.64 | $2,203.14 | $11,383.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,159.44 / $2,159.44 / $3,239.18
| Professional | | $2,159.44 | $2,159.44 | $3,239.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $705.73 / $2,351.08 / $4,185.97
| Facility | | $705.73 | $2,351.08 | $4,185.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.78 / $952.38 / $1,585.55
| Professional | | $675.78 | $952.38 | $1,585.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,051.48 / $2,159.44 / $2,375.40
| Professional | | $2,051.48 | $2,159.44 | $2,375.40 |