- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,659.59 / $4,897.79
| Facility | | $1,096.48 | $1,659.59 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,445.44 / $3,019.95
| Professional | | $371.54 | $1,445.44 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $5,888.44 / $7,943.28
| Facility | | $4,897.79 | $5,888.44 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $1,258.93 / $1,995.26
| Professional | | $269.15 | $1,258.93 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $549.54 / $2,570.40
| Professional | | $371.54 | $549.54 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,248.07 / $8,511.38
| Facility | | $1,698.24 | $5,248.07 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $1,318.26 / $2,344.23
| Professional | | $309.03 | $1,318.26 | $2,344.23 |