- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,754.23 / $3,981.07
| Facility | | $2,089.30 | $2,754.23 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $831.76 / $2,089.30
| Professional | | $251.19 | $831.76 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,311.31 / $11,481.54
| Facility | | $2,344.23 | $3,311.31 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $676.08 / $1,479.11
| Professional | | $263.03 | $676.08 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $831.76 / $2,454.71
| Professional | | $302.00 | $831.76 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,412.54 / $6,456.54
| Facility | | $436.52 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $602.56 / $1,995.26
| Professional | | $288.40 | $602.56 | $1,995.26 |