- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.76 / $3,243.94 / $3,955.04
| Facility | | $650.76 | $3,243.94 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.04 / $445.06 / $725.70
| Professional | | $300.04 | $445.06 | $725.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.22 / $501.77 / $895.05
| Professional | | $337.22 | $501.77 | $895.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.27 / $580.41 / $1,026.86
| Professional | | $465.27 | $580.41 | $1,026.86 |
- 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
- $413.64 / $606.21 / $1,072.73
| Professional | | $413.64 | $606.21 | $1,072.73 |