- 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
- $365.07 / $597.38 / $681.32
| Professional | | $365.07 | $597.38 | $681.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.69 / $586.41 / $865.01
| Professional | | $423.69 | $586.41 | $865.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $610.85 / $660.61 / $976.70
| Professional | | $610.85 | $660.61 | $976.70 |
- 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
- $409.92 / $623.11 / $994.01
| Professional | | $409.92 | $623.11 | $994.01 |