- 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
- $594.32 / $594.77 / $840.31
| Professional | | $594.32 | $594.77 | $840.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $674.02 / $792.97 / $1,325.40
| Professional | | $674.02 | $792.97 | $1,325.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.00 / $1,022.27 / $1,430.08
| Professional | | $250.00 | $1,022.27 | $1,430.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.00 / $2,384.00 / $5,510.00
| Facility | | $1,395.00 | $2,384.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $620.10 / $951.01 / $1,468.64
| Professional | | $620.10 | $951.01 | $1,468.64 |