- 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
- $861.13 / $1,110.18 / $1,348.37
| Professional | | $861.13 | $1,110.18 | $1,348.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,025.74 / $1,474.89 / $1,932.57
| Professional | | $1,025.74 | $1,474.89 | $1,932.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $690.27 / $1,437.34 / $2,457.48
| Professional | | $690.27 | $1,437.34 | $2,457.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $3,447.00 / $7,350.00
| Facility | | $2,654.00 | $3,447.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $961.49 / $1,479.82 / $2,597.71
| Professional | | $961.49 | $1,479.82 | $2,597.71 |