- 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
- $959.23 / $1,044.52 / $1,084.52
| Professional | | $959.23 | $1,044.52 | $1,084.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $983.22 / $1,156.73 / $1,798.41
| Professional | | $983.22 | $1,156.73 | $1,798.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $780.07 / $1,155.51 / $2,059.17
| Professional | | $780.07 | $1,155.51 | $2,059.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,417.00 / $4,915.00
| Facility | | $540.00 | $1,417.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.91 / $936.43 / $1,500.38
| Professional | | $691.91 | $936.43 | $1,500.38 |