- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,438.26 / $3,706.14 / $4,026.21
| Facility | | $3,438.26 | $3,706.14 | $4,026.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.02 / $352.53 / $354.14
| Professional | | $241.02 | $352.53 | $354.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.31 / $367.42 / $614.52
| Professional | | $312.31 | $367.42 | $614.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.65 / $498.38 / $645.42
| Professional | | $239.65 | $498.38 | $645.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $4,086.00 / $9,622.00
| Facility | | $3,146.00 | $4,086.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.27 / $397.90 / $680.31
| Professional | | $322.27 | $397.90 | $680.31 |