- 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
- $964.59 / $1,350.07 / $1,582.52
| Professional | | $964.59 | $1,350.07 | $1,582.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $916.19 / $1,268.08 / $2,020.34
| Professional | | $916.19 | $1,268.08 | $2,020.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,320.91 / $1,755.42 / $2,176.39
| Professional | | $1,320.91 | $1,755.42 | $2,176.39 |
- 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
- $939.10 / $1,508.60 / $2,324.17
| Professional | | $939.10 | $1,508.60 | $2,324.17 |