- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $3,706.14 / $3,955.04
| Facility | | $2,090.73 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.66 / $499.70 / $788.25
| Professional | | $352.66 | $499.70 | $788.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.36 / $470.75 / $990.60
| Professional | | $372.36 | $470.75 | $990.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.72 / $682.84 / $971.85
| Professional | | $487.72 | $682.84 | $971.85 |
- 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
- $425.66 / $703.17 / $1,088.88
| Professional | | $425.66 | $703.17 | $1,088.88 |