- 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
- $265.37 / $356.19 / $487.25
| Professional | | $265.37 | $356.19 | $487.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.33 / $476.66 / $650.61
| Professional | | $309.33 | $476.66 | $650.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.26 / $505.24 / $942.02
| Professional | | $362.26 | $505.24 | $942.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,049.00 / $5,510.00
| Facility | | $1,812.00 | $4,049.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.36 / $555.78 / $864.24
| Professional | | $332.36 | $555.78 | $864.24 |