- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,127.51 / $1,136.04 / $1,324.53
| Facility | | $1,127.51 | $1,136.04 | $1,324.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $931.31 / $1,172.63 / $1,597.75
| Professional | | $931.31 | $1,172.63 | $1,597.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,043.89 / $2,540.00 / $4,611.60
| Facility | | $2,043.89 | $2,540.00 | $4,611.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,242.91 / $1,242.91 / $1,832.95
| Professional | | $1,242.91 | $1,242.91 | $1,832.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,367.82 / $1,367.82 / $1,367.82
| Facility | | $1,367.82 | $1,367.82 | $1,367.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $998.51 / $1,338.42 / $1,458.16
| Professional | | $998.51 | $1,338.42 | $1,458.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $785.65 / $1,347.44 / $1,536.34
| Facility | | $785.65 | $1,347.44 | $1,536.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.69 / $1,054.88 / $1,612.86
| Professional | | $887.69 | $1,054.88 | $1,612.86 |