- 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
- $817.06 / $1,138.35 / $1,313.82
| Professional | | $817.06 | $1,138.35 | $1,313.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $805.03 / $1,114.22 / $1,665.78
| Professional | | $805.03 | $1,114.22 | $1,665.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,160.65 / $1,456.90 / $1,857.08
| Professional | | $1,160.65 | $1,456.90 | $1,857.08 |
- 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
- $738.39 / $1,152.20 / $1,889.62
| Professional | | $738.39 | $1,152.20 | $1,889.62 |