- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,706.14 / $10,042.66
| Facility | | $2,424.15 | $3,706.14 | $10,042.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.50 / $499.01 / $1,834.38
| Professional | | $321.50 | $499.01 | $1,834.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.02 / $687.49 / $2,203.98
| Professional | | $359.02 | $687.49 | $2,203.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.00 / $804.59 / $3,229.04
| Professional | | $226.00 | $804.59 | $3,229.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $4,086.00 / $9,622.00
| Facility | | $3,146.00 | $4,086.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,518.56 / $1,964.28 / $2,357.64
| Professional | | $1,518.56 | $1,964.28 | $2,357.64 |