- 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
- $587.29 / $816.26 / $955.81
| Professional | | $587.29 | $816.26 | $955.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.51 / $773.02 / $1,221.95
| Professional | | $558.51 | $773.02 | $1,221.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $805.22 / $1,020.21 / $1,314.97
| Professional | | $805.22 | $1,020.21 | $1,314.97 |
- 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
- $585.57 / $720.59 / $1,386.16
| Professional | | $585.57 | $720.59 | $1,386.16 |