- 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
- $946.31 / $1,210.89 / $1,588.91
| Professional | | $946.31 | $1,210.89 | $1,588.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $895.71 / $1,239.74 / $1,984.84
| Professional | | $895.71 | $1,239.74 | $1,984.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,291.39 / $1,524.28 / $2,149.65
| Professional | | $1,291.39 | $1,524.28 | $2,149.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,080.00 / $4,571.00 / $7,350.00
| Facility | | $2,080.00 | $4,571.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $936.61 / $1,340.74 / $2,251.57
| Professional | | $936.61 | $1,340.74 | $2,251.57 |