- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,167.80 / $4,600.62 / $7,082.13
| Facility | | $2,167.80 | $4,600.62 | $7,082.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.36 / $686.65 / $1,138.33
| Professional | | $486.36 | $686.65 | $1,138.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.78 / $893.15 / $1,393.52
| Professional | | $529.78 | $893.15 | $1,393.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.18 / $1,030.82 / $1,876.05
| Professional | | $766.18 | $1,030.82 | $1,876.05 |
- 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
- $723.41 / $1,309.72 / $1,822.94
| Professional | | $723.41 | $1,309.72 | $1,822.94 |