- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $1,543.03 / $3,955.04
| Facility | | $1,518.41 | $1,543.03 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.24 / $294.57 / $1,110.53
| Professional | | $174.24 | $294.57 | $1,110.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.69 / $634.29 / $940.30
| Professional | | $198.69 | $634.29 | $940.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $372.33 / $1,530.94
| Professional | | $150.00 | $372.33 | $1,530.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $3,447.00 / $7,350.00
| Facility | | $2,654.00 | $3,447.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.85 / $1,061.20 / $1,547.20
| Professional | | $761.85 | $1,061.20 | $1,547.20 |