- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,706.14 / $17,968.22
| Facility | | $2,424.15 | $3,706.14 | $17,968.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.03 / $1,249.83 / $8,547.35
| Professional | | $459.03 | $1,249.83 | $8,547.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $854.60 / $1,437.20 / $10,479.69
| Professional | | $854.60 | $1,437.20 | $10,479.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.12 / $1,511.61 / $14,594.85
| Professional | | $595.12 | $1,511.61 | $14,594.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,074.00 / $7,819.00 / $19,195.00
| Facility | | $5,074.00 | $7,819.00 | $19,195.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,537.81 / $8,923.54 / $15,786.96
| Professional | | $7,537.81 | $8,923.54 | $15,786.96 |