- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.69 / $2,797.26 / $8,836.57
| Facility | | $327.69 | $2,797.26 | $8,836.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.01 / $1,326.95 / $2,797.26
| Professional | | $271.01 | $1,326.95 | $2,797.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,024.89 / $3,670.84 / $4,938.46
| Facility | | $3,024.89 | $3,670.84 | $4,938.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.30 / $1,514.80 / $2,553.52
| Professional | | $399.30 | $1,514.80 | $2,553.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.66 / $1,340.16 / $3,479.04
| Professional | | $290.66 | $1,340.16 | $3,479.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,124.00 / $3,384.00 / $5,251.00
| Facility | | $1,124.00 | $3,384.00 | $5,251.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,504.06 / $2,088.77 / $2,917.88
| Professional | | $1,504.06 | $2,088.77 | $2,917.88 |