- 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
- $483.54 / $679.23 / $794.36
| Professional | | $483.54 | $679.23 | $794.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.32 / $645.41 / $1,001.42
| Professional | | $466.32 | $645.41 | $1,001.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $672.31 / $867.30 / $1,091.97
| Professional | | $672.31 | $867.30 | $1,091.97 |
- 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
- $447.78 / $748.52 / $1,135.99
| Professional | | $447.78 | $748.52 | $1,135.99 |