- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,754.40 / $10,232.93
| Facility | | $2,344.23 | $5,754.40 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $537.03 / $1,202.26
| Professional | | $371.54 | $537.03 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $524.81 / $851.14
| Professional | | $389.05 | $524.81 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $676.08 / $1,122.02
| Professional | | $302.00 | $676.08 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,677.35 / $8,128.31
| Facility | | $2,570.40 | $4,677.35 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $616.60 / $977.24
| Professional | | $407.38 | $616.60 | $977.24 |