- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $2,778.87 / $3,955.04
| Facility | | $2,090.73 | $2,778.87 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.04 / $313.86 / $1,471.06
| Professional | | $156.04 | $313.86 | $1,471.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,133.27 / $3,155.30 / $10,971.48
| Facility | | $2,133.27 | $3,155.30 | $10,971.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.16 / $525.44 / $2,148.41
| Professional | | $277.16 | $525.44 | $2,148.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.89 / $485.64 / $2,228.16
| Professional | | $235.89 | $485.64 | $2,228.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.61 / $1,389.71 / $2,316.75
| Professional | | $255.61 | $1,389.71 | $2,316.75 |