- 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
- $551.34 / $765.33 / $881.50
| Professional | | $551.34 | $765.33 | $881.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.76 / $726.32 / $1,134.34
| Professional | | $524.76 | $726.32 | $1,134.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $756.58 / $1,213.59 / $1,242.92
| Professional | | $756.58 | $1,213.59 | $1,242.92 |
- 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
- $549.12 / $850.35 / $1,286.78
| Professional | | $549.12 | $850.35 | $1,286.78 |