- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,981.07 / $7,762.47
| Facility | | $1,348.96 | $3,981.07 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,348.96 / $3,090.30
| Professional | | $758.58 | $1,348.96 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,412.54 / $1,698.24
| Professional | | $1,380.38 | $1,412.54 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,445.44 / $2,754.23
| Professional | | $954.99 | $1,445.44 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,398.83
| Professional | | $2,238.72 | $2,238.72 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,344.23 / $16,218.10
| Facility | | $645.65 | $2,344.23 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,513.56 / $3,090.30
| Professional | | $954.99 | $1,513.56 | $3,090.30 |