- 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
- $780.06 / $1,094.14 / $1,282.69
| Professional | | $780.06 | $1,094.14 | $1,282.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.66 / $1,025.14 / $1,635.96
| Professional | | $740.66 | $1,025.14 | $1,635.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,067.85 / $1,367.15 / $1,761.82
| Professional | | $1,067.85 | $1,367.15 | $1,761.82 |
- 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
- $778.35 / $1,221.24 / $1,855.80
| Professional | | $778.35 | $1,221.24 | $1,855.80 |