- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,993.72 / $3,706.14 / $3,955.04
| Facility | | $2,993.72 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.36 / $380.65 / $559.14
| Professional | | $342.36 | $380.65 | $559.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.55 / $549.33 / $753.10
| Professional | | $432.55 | $549.33 | $753.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.00 / $837.00 / $3,131.72
| Facility | | $837.00 | $837.00 | $3,131.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.35 / $661.51 / $962.72
| Professional | | $398.35 | $661.51 | $962.72 |
- 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
- $361.63 / $557.47 / $874.80
| Professional | | $361.63 | $557.47 | $874.80 |