- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,243.94 / $3,955.04
| Facility | | $2,424.15 | $3,243.94 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.43 / $560.86 / $595.16
| Professional | | $241.43 | $560.86 | $595.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $423.76 / $882.90 / $8,017.31
| Facility | | $423.76 | $882.90 | $8,017.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.63 / $423.76 / $423.76
| Professional | | $296.63 | $423.76 | $423.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,219.00 / $7,228.00 / $12,680.00
| Facility | | $3,219.00 | $7,228.00 | $12,680.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.47 / $492.71 / $697.12
| Professional | | $290.47 | $492.71 | $697.12 |