- 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
- $432.50 / $496.78 / $678.19
| Professional | | $432.50 | $496.78 | $678.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.32 / $719.02 / $841.58
| Professional | | $511.32 | $719.02 | $841.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.27 / $599.19 / $1,238.59
| Professional | | $356.27 | $599.19 | $1,238.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $4,628.00 / $7,350.00
| Facility | | $2,654.00 | $4,628.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.08 / $678.71 / $926.42
| Professional | | $440.08 | $678.71 | $926.42 |