- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $1,543.03 / $3,955.04
| Facility | | $1,518.41 | $1,543.03 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.01 / $365.40 / $387.28
| Professional | | $206.01 | $365.40 | $387.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.75 / $424.41 / $588.24
| Professional | | $360.75 | $424.41 | $588.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.79 / $388.10 / $740.78
| Professional | | $318.79 | $388.10 | $740.78 |
- 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
- $279.81 / $346.02 / $726.91
| Professional | | $279.81 | $346.02 | $726.91 |