- 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
- $930.69 / $1,044.13 / $1,088.31
| Professional | | $930.69 | $1,044.13 | $1,088.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $985.35 / $1,159.24 / $1,787.67
| Professional | | $985.35 | $1,159.24 | $1,787.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.50 / $1,163.70 / $2,073.44
| Professional | | $786.50 | $1,163.70 | $2,073.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $4,628.00 / $7,350.00
| Facility | | $2,654.00 | $4,628.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.10 / $974.78 / $1,451.73
| Professional | | $700.10 | $974.78 | $1,451.73 |