- 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
- $972.48 / $1,130.07 / $1,171.83
| Professional | | $972.48 | $1,130.07 | $1,171.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,061.93 / $1,249.33 / $1,918.01
| Professional | | $1,061.93 | $1,249.33 | $1,918.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $847.46 / $1,254.07 / $2,237.81
| Professional | | $847.46 | $1,254.07 | $2,237.81 |
- 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
- $725.60 / $1,030.35 / $1,514.11
| Professional | | $725.60 | $1,030.35 | $1,514.11 |