- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,955.04 / $9,982.67
| Facility | | $2,424.15 | $3,955.04 | $9,982.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.50 / $499.22 / $2,324.38
| Professional | | $321.50 | $499.22 | $2,324.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.44 / $693.88 / $2,768.88
| Professional | | $357.44 | $693.88 | $2,768.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.43 / $810.47 / $3,510.29
| Professional | | $228.43 | $810.47 | $3,510.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,838.00 / $4,086.00 / $9,622.00
| Facility | | $2,838.00 | $4,086.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,956.13 / $2,269.00 / $3,039.65
| Professional | | $1,956.13 | $2,269.00 | $3,039.65 |