- 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
- $427.94 / $486.19 / $699.00
| Professional | | $427.94 | $486.19 | $699.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.33 / $562.39 / $906.81
| Professional | | $406.33 | $562.39 | $906.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $621.03 / $860.47 / $1,074.17
| Professional | | $621.03 | $860.47 | $1,074.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,049.00 / $5,510.00
| Facility | | $1,812.00 | $4,049.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.81 / $733.83 / $1,028.66
| Professional | | $428.81 | $733.83 | $1,028.66 |