- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,454.71 / $3,981.07
| Facility | | $2,041.74 | $2,454.71 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $436.52 / $1,023.29
| Professional | | $302.00 | $436.52 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $316.23 / $524.81
| Professional | | $234.42 | $316.23 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $398.11 / $645.65
| Professional | | $89.13 | $398.11 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,677.35 / $7,585.78
| Facility | | $2,570.40 | $4,677.35 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $416.87 / $588.84
| Professional | | $275.42 | $416.87 | $588.84 |