- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $2,778.87 / $3,955.04
| Facility | | $2,090.73 | $2,778.87 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.74 / $502.43 / $669.86
| Professional | | $489.74 | $502.43 | $669.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.34 / $605.11 / $950.75
| Professional | | $514.34 | $605.11 | $950.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $662.85 / $1,005.56
| Professional | | $150.00 | $662.85 | $1,005.56 |
- 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
- $480.50 / $694.27 / $1,133.45
| Professional | | $480.50 | $694.27 | $1,133.45 |