- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,243.94 / $3,955.04
| Facility | | $2,424.15 | $3,243.94 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.87 / $1,259.31 / $1,674.31
| Professional | | $729.87 | $1,259.31 | $1,674.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $809.51 / $1,266.14 / $2,024.92
| Professional | | $809.51 | $1,266.14 | $2,024.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $962.27 / $1,504.35 / $3,035.30
| Professional | | $962.27 | $1,504.35 | $3,035.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,838.00 / $5,111.00 / $9,622.00
| Facility | | $2,838.00 | $5,111.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,162.54 / $1,932.08 / $2,933.16
| Professional | | $1,162.54 | $1,932.08 | $2,933.16 |