- 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
- $243.52 / $652.97 / $2,119.58
| Professional | | $243.52 | $652.97 | $2,119.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.17 / $754.55 / $2,669.28
| Professional | | $447.17 | $754.55 | $2,669.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.35 / $789.27 / $3,268.08
| Professional | | $325.35 | $789.27 | $3,268.08 |
- 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
- $1,627.28 / $2,286.28 / $3,555.66
| Professional | | $1,627.28 | $2,286.28 | $3,555.66 |