- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,706.14 / $65,093.51
| Facility | | $2,424.15 | $3,706.14 | $65,093.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.72 / $566.94 / $825.29
| Professional | | $311.72 | $566.94 | $825.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.86 / $403.96 / $942.79
| Professional | | $291.86 | $403.96 | $942.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.78 / $728.24 / $1,024.47
| Professional | | $420.78 | $728.24 | $1,024.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,569.00 / $4,571.00 / $7,350.00
| Facility | | $2,569.00 | $4,571.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.85 / $565.67 / $974.29
| Professional | | $312.85 | $565.67 | $974.29 |