- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $873.40 / $2,406.64 / $3,021.01
| Facility | | $873.40 | $2,406.64 | $3,021.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.54 / $2,451.10 / $3,269.60
| Professional | | $471.54 | $2,451.10 | $3,269.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $473.59 / $1,037.56 / $2,149.42
| Facility | | $473.59 | $1,037.56 | $2,149.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.33 / $877.37 / $3,424.05
| Professional | | $319.33 | $877.37 | $3,424.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.30 / $1,007.64 / $4,015.82
| Facility | | $425.30 | $1,007.64 | $4,015.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.12 / $351.19 / $593.63
| Professional | | $229.12 | $351.19 | $593.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,326.58 / $2,802.63 / $3,948.11
| Facility | | $2,326.58 | $2,802.63 | $3,948.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.27 / $1,672.75 / $3,345.50
| Professional | | $281.27 | $1,672.75 | $3,345.50 |