- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,993.72 / $3,706.14 / $3,955.04
| Facility | | $2,993.72 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.73 / $322.52 / $467.85
| Professional | | $286.73 | $322.52 | $467.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.87 / $391.52 / $592.66
| Professional | | $282.87 | $391.52 | $592.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.84 / $495.85 / $647.08
| Professional | | $407.84 | $495.85 | $647.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,049.00 / $5,510.00
| Facility | | $1,812.00 | $4,049.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.58 / $396.36 / $672.31
| Professional | | $261.58 | $396.36 | $672.31 |