- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,888.44 / $10,964.78
| Facility | | $3,311.31 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $389.05 / $1,000.00
| Professional | | $281.84 | $389.05 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $398.11 / $549.54
| Professional | | $234.42 | $398.11 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $489.78 / $1,047.13
| Professional | | $338.84 | $489.78 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,884.03 / $7,762.47
| Facility | | $1,412.54 | $2,884.03 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $446.68 / $912.01
| Professional | | $257.04 | $446.68 | $912.01 |