- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,706.14 / $5,222.66
| Facility | | $2,424.15 | $3,706.14 | $5,222.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.03 / $643.95 / $741.74
| Professional | | $471.03 | $643.95 | $741.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.46 / $658.08 / $939.98
| Professional | | $475.46 | $658.08 | $939.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.50 / $858.37 / $1,060.48
| Professional | | $685.50 | $858.37 | $1,060.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,049.00 / $5,510.00
| Facility | | $1,812.00 | $4,049.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.88 / $679.84 / $1,066.29
| Professional | | $461.88 | $679.84 | $1,066.29 |