- 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
- $162.44 / $340.49 / $1,353.67
| Professional | | $162.44 | $340.49 | $1,353.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.77 / $550.69 / $1,328.02
| Professional | | $123.77 | $550.69 | $1,328.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.14 / $367.51 / $2,502.76
| Professional | | $122.14 | $367.51 | $2,502.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $5,164.00 / $9,622.00
| Facility | | $3,146.00 | $5,164.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $915.51 / $1,457.17 / $2,003.22
| Professional | | $915.51 | $1,457.17 | $2,003.22 |