- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $5,888.44 / $9,549.93
| Facility | | $4,365.16 | $5,888.44 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $1,513.56 / $2,137.96
| Professional | | $537.03 | $1,513.56 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,905.46 / $1,905.46
| Professional | | $1,479.11 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $724.44 / $1,023.29
| Professional | | $616.60 | $724.44 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,168.69 / $6,918.31
| Facility | | $1,202.26 | $4,168.69 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,398.83 / $3,715.35
| Professional | | $1,047.13 | $2,398.83 | $3,715.35 |