- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,757.72 / $4,612.50 / $10,796.47
| Facility | | $2,757.72 | $4,612.50 | $10,796.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.28 / $703.17 / $1,493.95
| Professional | | $236.28 | $703.17 | $1,493.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.28 / $734.24 / $1,949.95
| Professional | | $435.28 | $734.24 | $1,949.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.58 / $812.43 / $2,364.31
| Professional | | $265.58 | $812.43 | $2,364.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,838.00 / $4,086.00 / $9,622.00
| Facility | | $2,838.00 | $4,086.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,352.81 / $1,535.87 / $2,384.37
| Professional | | $1,352.81 | $1,535.87 | $2,384.37 |