- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,955.04 / $10,123.76
| Facility | | $2,424.15 | $3,955.04 | $10,123.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $858.03 / $1,227.35 / $1,379.84
| Professional | | $858.03 | $1,227.35 | $1,379.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $850.70 / $1,177.44 / $1,791.04
| Professional | | $850.70 | $1,177.44 | $1,791.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.50 / $1,519.73 / $1,978.43
| Professional | | $1,226.50 | $1,519.73 | $1,978.43 |
- 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
- $851.20 / $1,346.38 / $2,047.64
| Professional | | $851.20 | $1,346.38 | $2,047.64 |