- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,659.59 / $2,344.23
| Facility | | $1,096.48 | $1,659.59 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $1,122.02 / $2,290.87
| Professional | | $309.03 | $1,122.02 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $6,918.31 / $9,332.54
| Facility | | $5,754.40 | $6,918.31 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $1,258.93 / $2,137.96
| Professional | | $338.84 | $1,258.93 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $1,230.27 / $2,754.23
| Professional | | $323.59 | $1,230.27 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,365.16 / $6,606.93
| Facility | | $1,479.11 | $4,365.16 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $1,318.26 / $2,691.53
| Professional | | $295.12 | $1,318.26 | $2,691.53 |