- 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
- $57.42 / $87.66 / $1,502.68
| Professional | | $57.42 | $87.66 | $1,502.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.67 / $139.25 / $1,517.26
| Professional | | $51.67 | $139.25 | $1,517.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.22 / $131.68 / $2,897.04
| Professional | | $43.22 | $131.68 | $2,897.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,052.00 / $5,510.00
| Facility | | $1,812.00 | $4,052.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,049.40 / $1,494.53 / $2,248.84
| Professional | | $1,049.40 | $1,494.53 | $2,248.84 |