- 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
- $406.12 / $717.61 / $826.78
| Professional | | $406.12 | $717.61 | $826.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.25 / $745.00 / $1,208.23
| Professional | | $633.25 | $745.00 | $1,208.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.94 / $923.40 / $1,786.17
| Professional | | $488.94 | $923.40 | $1,786.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $4,086.00 / $9,622.00
| Facility | | $3,146.00 | $4,086.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $698.37 / $745.30 / $1,371.01
| Professional | | $698.37 | $745.30 | $1,371.01 |