- 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
- $212.55 / $548.25 / $2,647.55
| Professional | | $212.55 | $548.25 | $2,647.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,730.84 / $5,545.76 / $6,758.74
| Facility | | $3,730.84 | $5,545.76 | $6,758.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.05 / $806.66 / $4,173.57
| Professional | | $436.05 | $806.66 | $4,173.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.14 / $752.36 / $3,913.05
| Professional | | $362.14 | $752.36 | $3,913.05 |
- 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
- $345.79 / $2,505.36 / $4,288.88
| Professional | | $345.79 | $2,505.36 | $4,288.88 |