- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,706.14 / $4,483.05
| Facility | | $2,424.15 | $3,706.14 | $4,483.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.67 / $692.54 / $1,291.54
| Professional | | $468.67 | $692.54 | $1,291.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.40 / $840.58 / $1,369.42
| Professional | | $520.40 | $840.58 | $1,369.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $757.44 / $961.38 / $1,753.78
| Professional | | $757.44 | $961.38 | $1,753.78 |
- 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
- $613.57 / $1,072.31 / $1,635.74
| Professional | | $613.57 | $1,072.31 | $1,635.74 |