- 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
- $717.02 / $1,002.42 / $1,145.34
| Professional | | $717.02 | $1,002.42 | $1,145.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.13 / $942.74 / $1,495.95
| Professional | | $681.13 | $942.74 | $1,495.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $982.02 / $1,249.56 / $1,614.81
| Professional | | $982.02 | $1,249.56 | $1,614.81 |
- 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
- $697.10 / $1,119.33 / $1,696.97
| Professional | | $697.10 | $1,119.33 | $1,696.97 |