- 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
- $247.52 / $390.88 / $623.90
| Professional | | $247.52 | $390.88 | $623.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.07 / $408.16 / $721.21
| Professional | | $272.07 | $408.16 | $721.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.50 / $474.07 / $857.18
| Professional | | $376.50 | $474.07 | $857.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,569.00 / $4,571.00 / $7,350.00
| Facility | | $2,569.00 | $4,571.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.79 / $596.21 / $912.31
| Professional | | $338.79 | $596.21 | $912.31 |