- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,243.94 / $3,955.04
| Facility | | $2,424.15 | $3,243.94 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.96 / $243.14 / $267.73
| Professional | | $141.96 | $243.14 | $267.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.11 / $254.25 / $424.00
| Professional | | $216.11 | $254.25 | $424.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.77 / $336.49 / $621.16
| Professional | | $160.77 | $336.49 | $621.16 |
- 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
- $232.53 / $302.27 / $469.62
| Professional | | $232.53 | $302.27 | $469.62 |