- 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
- $210.02 / $493.29 / $1,961.13
| Professional | | $210.02 | $493.29 | $1,961.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.36 / $653.12 / $2,514.11
| Professional | | $387.36 | $653.12 | $2,514.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.03 / $870.87 / $3,748.74
| Professional | | $236.03 | $870.87 | $3,748.74 |
- 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
- $1,811.31 / $2,274.23 / $3,699.76
| Professional | | $1,811.31 | $2,274.23 | $3,699.76 |