- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,469.55 / $3,955.04
| Facility | | $2,424.15 | $3,469.55 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.37 / $408.48 / $720.66
| Professional | | $227.37 | $408.48 | $720.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.45 / $439.24 / $739.41
| Professional | | $253.45 | $439.24 | $739.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.17 / $509.20 / $981.92
| Professional | | $365.17 | $509.20 | $981.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,080.00 / $4,571.00 / $7,350.00
| Facility | | $2,080.00 | $4,571.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.53 / $680.63 / $1,042.57
| Professional | | $343.53 | $680.63 | $1,042.57 |