- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,088.58 / $1,543.03 / $3,955.04
| Facility | | $1,088.58 | $1,543.03 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.24 / $257.18 / $4,900.17
| Professional | | $177.24 | $257.18 | $4,900.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.25 / $2,402.39 / $6,178.97
| Professional | | $202.25 | $2,402.39 | $6,178.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.29 / $380.19 / $6,337.16
| Professional | | $195.29 | $380.19 | $6,337.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,596.00 / $7,457.00 / $12,945.00
| Facility | | $4,596.00 | $7,457.00 | $12,945.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,799.68 / $4,410.32 / $6,844.34
| Professional | | $2,799.68 | $4,410.32 | $6,844.34 |