- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,981.07 / $5,754.40
| Facility | | $2,951.21 | $3,981.07 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $6,606.93 / $12,022.64
| Professional | | $602.56 | $6,606.93 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $44.67 / $60.26
| Professional | | $30.20 | $44.67 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $398.11 / $870.96
| Facility | | $338.84 | $398.11 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,677.35 / $4,786.30
| Professional | | $3,801.89 | $4,677.35 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,466.84 / $5,128.61
| Facility | | $1,071.52 | $4,466.84 | $5,128.61 |