- 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
- $800.59 / $1,118.82 / $1,288.22
| Professional | | $800.59 | $1,118.82 | $1,288.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $784.82 / $1,086.26 / $1,638.47
| Professional | | $784.82 | $1,086.26 | $1,638.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,131.52 / $1,428.47 / $1,816.51
| Professional | | $1,131.52 | $1,428.47 | $1,816.51 |
- 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
- $762.38 / $1,167.31 / $1,891.31
| Professional | | $762.38 | $1,167.31 | $1,891.31 |