- 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
- $81.37 / $141.76 / $203.10
| Professional | | $81.37 | $141.76 | $203.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.05 / $157.71 / $243.60
| Professional | | $134.05 | $157.71 | $243.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.65 / $195.36 / $352.17
| Professional | | $93.65 | $195.36 | $352.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,596.00 / $7,457.00 / $12,945.00
| Facility | | $4,596.00 | $7,457.00 | $12,945.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.82 / $178.89 / $269.29
| Professional | | $145.82 | $178.89 | $269.29 |