- 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
- $738.42 / $841.90 / $950.81
| Professional | | $738.42 | $841.90 | $950.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.56 / $1,006.54 / $1,436.27
| Professional | | $855.56 | $1,006.54 | $1,436.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $661.96 / $1,028.30 / $1,842.94
| Professional | | $661.96 | $1,028.30 | $1,842.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $5,164.00 / $9,622.00
| Facility | | $3,146.00 | $5,164.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.12 / $796.07 / $1,173.16
| Professional | | $569.12 | $796.07 | $1,173.16 |