- 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
- $398.68 / $539.76 / $634.23
| Professional | | $398.68 | $539.76 | $634.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.60 / $514.33 / $861.67
| Professional | | $371.60 | $514.33 | $861.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.76 / $720.20 / $883.78
| Professional | | $535.76 | $720.20 | $883.78 |
- 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
- $390.44 / $600.00 / $944.48
| Professional | | $390.44 | $600.00 | $944.48 |