- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,637.00 / $3,955.04
| Facility | | $2,424.15 | $3,637.00 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.16 / $719.39 / $838.27
| Professional | | $517.16 | $719.39 | $838.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $495.86 / $686.32 / $1,067.34
| Professional | | $495.86 | $686.32 | $1,067.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.91 / $924.53 / $1,156.08
| Professional | | $714.91 | $924.53 | $1,156.08 |
- 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
- $459.67 / $728.28 / $1,210.79
| Professional | | $459.67 | $728.28 | $1,210.79 |