- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $2,778.87 / $3,955.04
| Facility | | $2,090.73 | $2,778.87 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.68 / $450.11 / $695.56
| Professional | | $286.68 | $450.11 | $695.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.83 / $471.68 / $828.49
| Professional | | $320.83 | $471.68 | $828.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.84 / $571.84 / $950.37
| Professional | | $431.84 | $571.84 | $950.37 |
- 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
- $408.52 / $658.76 / $1,014.09
| Professional | | $408.52 | $658.76 | $1,014.09 |