- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $1,543.03 / $3,955.04
| Facility | | $1,518.41 | $1,543.03 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.25 / $1,025.31 / $1,270.85
| Professional | | $715.25 | $1,025.31 | $1,270.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.19 / $934.52 / $1,684.89
| Professional | | $675.19 | $934.52 | $1,684.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $973.47 / $1,393.97 / $1,671.47
| Professional | | $973.47 | $1,393.97 | $1,671.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,713.00 / $7,457.00 / $12,945.00
| Facility | | $3,713.00 | $7,457.00 | $12,945.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $722.82 / $1,163.58 / $1,779.91
| Professional | | $722.82 | $1,163.58 | $1,779.91 |