- 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
- $937.15 / $1,273.08 / $1,505.70
| Professional | | $937.15 | $1,273.08 | $1,505.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $856.85 / $1,185.95 / $2,007.63
| Professional | | $856.85 | $1,185.95 | $2,007.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,186.26 / $1,716.68 / $2,094.80
| Professional | | $1,186.26 | $1,716.68 | $2,094.80 |
- 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
- $832.91 / $1,452.04 / $2,217.59
| Professional | | $832.91 | $1,452.04 | $2,217.59 |