- 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
- $583.87 / $634.62 / $782.97
| Professional | | $583.87 | $634.62 | $782.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $701.78 / $825.62 / $1,083.36
| Professional | | $701.78 | $825.62 | $1,083.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $544.97 / $836.73 / $1,524.80
| Professional | | $544.97 | $836.73 | $1,524.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $5,164.00 / $9,622.00
| Facility | | $3,146.00 | $5,164.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $502.80 / $631.52 / $947.11
| Professional | | $502.80 | $631.52 | $947.11 |