- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,706.14 / $11,111.85
| Facility | | $2,424.15 | $3,706.14 | $11,111.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.54 / $666.40 / $813.61
| Professional | | $555.54 | $666.40 | $813.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.90 / $852.21 / $1,146.83
| Professional | | $581.90 | $852.21 | $1,146.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $688.55 / $922.32 / $1,642.77
| Professional | | $688.55 | $922.32 | $1,642.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,049.00 / $5,510.00
| Facility | | $1,812.00 | $4,049.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.46 / $1,024.59 / $1,512.75
| Professional | | $615.46 | $1,024.59 | $1,512.75 |