- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,706.14 / $7,479.71
| Facility | | $2,424.15 | $3,706.14 | $7,479.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.47 / $420.25 / $643.04
| Professional | | $387.47 | $420.25 | $643.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.80 / $514.60 / $825.58
| Professional | | $371.80 | $514.60 | $825.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.04 / $706.91 / $876.20
| Professional | | $536.04 | $706.91 | $876.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,838.00 / $5,111.00 / $9,622.00
| Facility | | $2,838.00 | $5,111.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.36 / $599.83 / $936.51
| Professional | | $383.36 | $599.83 | $936.51 |