- 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
- $394.08 / $434.02 / $499.37
| Professional | | $394.08 | $434.02 | $499.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.19 / $536.69 / $746.53
| Professional | | $456.19 | $536.69 | $746.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.47 / $513.97 / $958.72
| Professional | | $324.47 | $513.97 | $958.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,052.00 / $5,510.00
| Facility | | $1,812.00 | $4,052.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.10 / $455.52 / $703.76
| Professional | | $380.10 | $455.52 | $703.76 |