- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,993.72 / $3,706.14 / $3,955.04
| Facility | | $2,993.72 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.20 / $460.03 / $517.02
| Professional | | $266.20 | $460.03 | $517.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.52 / $498.26 / $772.32
| Professional | | $423.52 | $498.26 | $772.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.75 / $544.89 / $872.39
| Professional | | $380.75 | $544.89 | $872.39 |
- 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
- $393.74 / $491.83 / $853.04
| Professional | | $393.74 | $491.83 | $853.04 |