- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,706.14 / $5,295.57
| Facility | | $2,424.15 | $3,706.14 | $5,295.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.78 / $605.27 / $887.21
| Professional | | $440.78 | $605.27 | $887.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $721.91 / $849.31 / $1,363.66
| Professional | | $721.91 | $849.31 | $1,363.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.01 / $1,005.12 / $1,940.14
| Professional | | $559.01 | $1,005.12 | $1,940.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $4,086.00 / $9,622.00
| Facility | | $3,146.00 | $4,086.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.72 / $952.60 / $1,472.61
| Professional | | $638.72 | $952.60 | $1,472.61 |