- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $3,706.14 / $11,560.89
| Facility | | $2,090.73 | $3,706.14 | $11,560.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.50 / $393.30 / $514.03
| Professional | | $330.50 | $393.30 | $514.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.08 / $526.30 / $710.15
| Professional | | $342.08 | $526.30 | $710.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.42 / $563.13 / $1,046.67
| Professional | | $410.42 | $563.13 | $1,046.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,569.00 / $4,571.00 / $7,350.00
| Facility | | $2,569.00 | $4,571.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.50 / $574.41 / $966.53
| Professional | | $395.50 | $574.41 | $966.53 |