- 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
- $356.63 / $496.97 / $587.96
| Professional | | $356.63 | $496.97 | $587.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.44 / $468.42 / $743.96
| Professional | | $338.44 | $468.42 | $743.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.94 / $611.54 / $814.08
| Professional | | $487.94 | $611.54 | $814.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,838.00 / $5,111.00 / $9,622.00
| Facility | | $2,838.00 | $5,111.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.32 / $564.29 / $859.30
| Professional | | $352.32 | $564.29 | $859.30 |