- 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
- $356.14 / $383.20 / $587.71
| Professional | | $356.14 | $383.20 | $587.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.87 / $467.63 / $756.76
| Professional | | $337.87 | $467.63 | $756.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.11 / $663.11 / $805.04
| Professional | | $487.11 | $663.11 | $805.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,713.00 / $7,457.00 / $12,945.00
| Facility | | $3,713.00 | $7,457.00 | $12,945.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.23 / $564.87 / $858.45
| Professional | | $367.23 | $564.87 | $858.45 |