- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,018.91 / $2,424.15 / $3,955.04
| Facility | | $2,018.91 | $2,424.15 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.41 / $521.85 / $768.79
| Professional | | $468.41 | $521.85 | $768.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.89 / $626.83 / $978.40
| Professional | | $452.89 | $626.83 | $978.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.95 / $816.65 / $1,054.17
| Professional | | $652.95 | $816.65 | $1,054.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,838.00 / $5,111.00 / $9,622.00
| Facility | | $2,838.00 | $5,111.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.25 / $730.71 / $1,144.61
| Professional | | $426.25 | $730.71 | $1,144.61 |