- 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
- $128.54 / $293.97 / $2,280.82
| Professional | | $128.54 | $293.97 | $2,280.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.82 / $775.46 / $2,253.02
| Professional | | $186.82 | $775.46 | $2,253.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.42 / $368.78 / $3,893.59
| Professional | | $188.42 | $368.78 | $3,893.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $4,086.00 / $9,622.00
| Facility | | $3,146.00 | $4,086.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,720.14 / $2,698.89 / $4,164.97
| Professional | | $1,720.14 | $2,698.89 | $4,164.97 |