- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,896.32 / $2,340.30 / $3,955.04
| Facility | | $1,896.32 | $2,340.30 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.31 / $351.37 / $505.44
| Professional | | $316.31 | $351.37 | $505.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.49 / $428.36 / $641.66
| Professional | | $309.49 | $428.36 | $641.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.21 / $616.72 / $700.71
| Professional | | $446.21 | $616.72 | $700.71 |
- 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
- $309.56 / $495.30 / $727.88
| Professional | | $309.56 | $495.30 | $727.88 |