- 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
- $764.70 / $1,068.08 / $1,158.63
| Professional | | $764.70 | $1,068.08 | $1,158.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.46 / $1,041.47 / $1,562.09
| Professional | | $752.46 | $1,041.47 | $1,562.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,084.85 / $1,362.58 / $1,734.46
| Professional | | $1,084.85 | $1,362.58 | $1,734.46 |
- 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
- $689.64 / $1,076.83 / $1,772.01
| Professional | | $689.64 | $1,076.83 | $1,772.01 |