- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,361.60 / $4,608.72 / $10,147.43
| Facility | | $2,361.60 | $4,608.72 | $10,147.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.60 / $450.10 / $618.41
| Professional | | $341.60 | $450.10 | $618.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $691.14 / $853.92
| Professional | | $489.78 | $691.14 | $853.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.25 / $717.38 / $1,210.06
| Professional | | $341.25 | $717.38 | $1,210.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $3,447.00 / $7,350.00
| Facility | | $2,654.00 | $3,447.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.42 / $750.72 / $1,118.44
| Professional | | $481.42 | $750.72 | $1,118.44 |