- 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
- $470.56 / $527.48 / $768.40
| Professional | | $470.56 | $527.48 | $768.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.11 / $632.67 / $976.75
| Professional | | $457.11 | $632.67 | $976.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $659.04 / $820.62 / $1,062.68
| Professional | | $659.04 | $820.62 | $1,062.68 |
- 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
- $446.01 / $736.61 / $1,136.47
| Professional | | $446.01 | $736.61 | $1,136.47 |