- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,700.09 / $3,955.04
| Facility | | $2,424.15 | $3,700.09 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $949.69 / $1,302.08 / $1,762.11
| Professional | | $949.69 | $1,302.08 | $1,762.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $871.31 / $1,205.96 / $2,254.17
| Professional | | $871.31 | $1,205.96 | $2,254.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,256.22 / $1,840.59 / $2,285.34
| Professional | | $1,256.22 | $1,840.59 | $2,285.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,569.00 / $4,571.00 / $7,350.00
| Facility | | $2,569.00 | $4,571.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $908.67 / $1,395.84 / $2,211.83
| Professional | | $908.67 | $1,395.84 | $2,211.83 |