- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $3,955.04 / $9,074.42
| Facility | | $2,090.73 | $3,955.04 | $9,074.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.07 / $423.72 / $1,030.81
| Professional | | $204.07 | $423.72 | $1,030.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.35 / $648.54 / $1,140.45
| Professional | | $246.35 | $648.54 | $1,140.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.64 / $465.03 / $1,878.28
| Professional | | $175.64 | $465.03 | $1,878.28 |
- 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
- $666.90 / $1,092.72 / $1,742.58
| Professional | | $666.90 | $1,092.72 | $1,742.58 |