- 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
- $144.77 / $208.13 / $311.99
| Professional | | $144.77 | $208.13 | $311.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.77 / $239.28 / $391.46
| Professional | | $172.77 | $239.28 | $391.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.48 / $286.14 / $429.87
| Professional | | $225.48 | $286.14 | $429.87 |
- 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
- $189.67 / $303.33 / $468.70
| Professional | | $189.67 | $303.33 | $468.70 |