- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,127.18 / $1,127.18 / $1,352.62
| Facility | | $1,127.18 | $1,127.18 | $1,352.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $854.01 / $1,091.94 / $1,130.26
| Professional | | $854.01 | $1,091.94 | $1,130.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,001.86 / $2,001.86 / $2,373.00
| Facility | | $2,001.86 | $2,001.86 | $2,373.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,136.98 / $1,136.98 / $1,200.91
| Professional | | $1,136.98 | $1,136.98 | $1,200.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.46 / $1,277.46 / $1,277.46
| Facility | | $1,277.46 | $1,277.46 | $1,277.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $932.55 / $932.55 / $1,471.33
| Professional | | $932.55 | $932.55 | $1,471.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,620.81 / $1,620.81 / $5,002.63
| Professional | | $1,620.81 | $1,620.81 | $5,002.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $665.80 / $998.71 / $1,229.74
| Professional | | $665.80 | $998.71 | $1,229.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,499.32 / $1,649.25 / $2,099.05
| Professional | | $1,499.32 | $1,649.25 | $2,099.05 |