- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,706.14 / $20,210.20
| Facility | | $2,424.15 | $3,706.14 | $20,210.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.20 / $780.21 / $1,304.48
| Professional | | $538.20 | $780.21 | $1,304.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $613.87 / $966.93 / $1,630.78
| Professional | | $613.87 | $966.93 | $1,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $895.57 / $1,169.79 / $2,181.62
| Professional | | $895.57 | $1,169.79 | $2,181.62 |
- 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
- $764.42 / $1,514.55 / $2,115.29
| Professional | | $764.42 | $1,514.55 | $2,115.29 |