- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $2,778.87 / $3,955.04
| Facility | | $2,090.73 | $2,778.87 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.91 / $614.45 / $810.28
| Professional | | $605.91 | $614.45 | $810.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.62 / $847.79 / $1,216.02
| Professional | | $720.62 | $847.79 | $1,216.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $703.13 / $1,011.06 / $1,293.81
| Professional | | $703.13 | $1,011.06 | $1,293.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,569.00 / $4,571.00 / $7,350.00
| Facility | | $2,569.00 | $4,571.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.89 / $776.79 / $1,357.01
| Professional | | $543.89 | $776.79 | $1,357.01 |