- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,324.27 / $1,876.06 / $9,220.04
| Facility | | $1,324.27 | $1,876.06 | $9,220.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,868.75 / $1,868.75 / $1,922.39
| Professional | | $1,868.75 | $1,868.75 | $1,922.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $874.69 / $1,367.81 / $2,128.50
| Facility | | $874.69 | $1,367.81 | $2,128.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,632.38 / $1,632.38 / $1,730.32
| Facility | | $1,632.38 | $1,632.38 | $1,730.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.82 / $1,730.32 / $1,730.32
| Professional | | $552.82 | $1,730.32 | $1,730.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,269.23 / $1,737.10 / $3,112.72
| Facility | | $1,269.23 | $1,737.10 | $3,112.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,670.30 / $1,737.10 / $1,933.76
| Professional | | $1,670.30 | $1,737.10 | $1,933.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,730.32 / $1,730.32 / $1,926.21
| Professional | | $1,730.32 | $1,730.32 | $1,926.21 |