- 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
- $365.55 / $531.37 / $998.70
| Professional | | $365.55 | $531.37 | $998.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.50 / $646.47 / $1,146.94
| Professional | | $430.50 | $646.47 | $1,146.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.20 / $760.05 / $1,591.72
| Professional | | $275.20 | $760.05 | $1,591.72 |
- 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
- $620.79 / $737.48 / $1,211.97
| Professional | | $620.79 | $737.48 | $1,211.97 |