- 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
- $140.49 / $485.00 / $1,446.03
| Professional | | $140.49 | $485.00 | $1,446.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.72 / $498.20 / $2,172.26
| Professional | | $256.72 | $498.20 | $2,172.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.66 / $507.61 / $2,177.91
| Professional | | $223.66 | $507.61 | $2,177.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,838.00 / $5,111.00 / $9,622.00
| Facility | | $2,838.00 | $5,111.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,051.40 / $1,509.65 / $2,243.66
| Professional | | $1,051.40 | $1,509.65 | $2,243.66 |