- 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
- $413.44 / $474.26 / $607.94
| Professional | | $413.44 | $474.26 | $607.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.48 / $641.12 / $812.12
| Professional | | $487.48 | $641.12 | $812.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.73 / $539.27 / $1,100.95
| Professional | | $339.73 | $539.27 | $1,100.95 |
- 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
- $362.54 / $543.61 / $831.88
| Professional | | $362.54 | $543.61 | $831.88 |