- 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
- $783.07 / $1,104.46 / $1,295.70
| Professional | | $783.07 | $1,104.46 | $1,295.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $747.74 / $1,034.93 / $1,651.37
| Professional | | $747.74 | $1,034.93 | $1,651.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,078.05 / $1,384.88 / $1,780.36
| Professional | | $1,078.05 | $1,384.88 | $1,780.36 |
- 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
- $707.89 / $1,076.43 / $1,769.07
| Professional | | $707.89 | $1,076.43 | $1,769.07 |