- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $2,398.83
| Facility | | $1,096.48 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,202.26 / $1,949.84
| Professional | | $912.01 | $1,202.26 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $6,025.60 / $8,128.31
| Facility | | $5,011.87 | $6,025.60 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,348.96 / $1,584.89
| Professional | | $933.25 | $1,348.96 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,348.96 / $1,737.80
| Professional | | $741.31 | $1,348.96 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,630.78 / $5,128.61
| Facility | | $1,122.02 | $3,630.78 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,023.29 / $1,513.56
| Professional | | $707.95 | $1,023.29 | $1,513.56 |