- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,243.94 / $3,955.04
| Facility | | $2,424.15 | $3,243.94 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.69 / $724.22 / $811.13
| Professional | | $383.69 | $724.22 | $811.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $639.22 / $752.02 / $1,340.15
| Professional | | $639.22 | $752.02 | $1,340.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $493.31 / $932.12 / $1,696.90
| Professional | | $493.31 | $932.12 | $1,696.90 |
- 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
- $703.46 / $830.22 / $1,724.48
| Professional | | $703.46 | $830.22 | $1,724.48 |