- 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
- $552.42 / $770.49 / $884.23
| Professional | | $552.42 | $770.49 | $884.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.16 / $731.04 / $1,142.40
| Professional | | $528.16 | $731.04 | $1,142.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.51 / $1,209.24 / $1,251.01
| Professional | | $761.51 | $1,209.24 | $1,251.01 |
- 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
- $553.85 / $873.05 / $1,320.99
| Professional | | $553.85 | $873.05 | $1,320.99 |