- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,862.09 / $3,388.44
| Facility | | $1,318.26 | $1,862.09 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $851.14 / $1,258.93
| Professional | | $602.56 | $851.14 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,137.96 / $3,548.13
| Facility | | $1,621.81 | $2,137.96 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $3,235.94 / $5,128.61
| Professional | | $588.84 | $3,235.94 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,122.02 / $4,786.30
| Facility | | $851.14 | $1,122.02 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,398.83 / $2,818.38
| Professional | | $1,778.28 | $2,398.83 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $676.08 / $1,995.26
| Professional | | $562.34 | $676.08 | $1,995.26 |