- 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
- $555.12 / $641.42 / $926.09
| Professional | | $555.12 | $641.42 | $926.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.02 / $740.52 / $1,203.80
| Professional | | $535.02 | $740.52 | $1,203.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $771.37 / $1,010.10 / $1,273.06
| Professional | | $771.37 | $1,010.10 | $1,273.06 |
- 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
- $500.45 / $820.26 / $1,363.67
| Professional | | $500.45 | $820.26 | $1,363.67 |