- 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
- $405.54 / $450.86 / $660.33
| Professional | | $405.54 | $450.86 | $660.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.85 / $542.35 / $842.31
| Professional | | $391.85 | $542.35 | $842.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $564.95 / $706.22 / $911.52
| Professional | | $564.95 | $706.22 | $911.52 |
- 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
- $384.77 / $639.58 / $989.67
| Professional | | $384.77 | $639.58 | $989.67 |