- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,454.71 / $6,606.93
| Facility | | $912.01 | $2,454.71 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $1,096.48 / $1,621.81
| Professional | | $223.87 | $1,096.48 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,071.52 / $5,888.44
| Facility | | $501.19 | $1,071.52 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,288.25 / $2,187.76
| Professional | | $741.31 | $1,288.25 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,949.84 / $6,165.95
| Facility | | $346.74 | $1,949.84 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,148.15 / $1,737.80
| Professional | | $660.69 | $1,148.15 | $1,737.80 |