- 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
- $83.45 / $226.11 / $2,009.17
| Professional | | $83.45 | $226.11 | $2,009.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.12 / $259.60 / $2,640.87
| Professional | | $155.12 | $259.60 | $2,640.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.51 / $343.02 / $3,164.62
| Professional | | $95.51 | $343.02 | $3,164.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.00 / $2,384.00 / $5,510.00
| Facility | | $1,395.00 | $2,384.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,767.85 / $2,164.38 / $3,370.10
| Professional | | $1,767.85 | $2,164.38 | $3,370.10 |