- 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
- $438.93 / $520.79 / $686.67
| Professional | | $438.93 | $520.79 | $686.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.28 / $710.46 / $872.70
| Professional | | $517.28 | $710.46 | $872.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.49 / $604.27 / $1,219.18
| Professional | | $365.49 | $604.27 | $1,219.18 |
- 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
- $410.36 / $616.26 / $928.44
| Professional | | $410.36 | $616.26 | $928.44 |