- 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
- $292.37 / $488.14 / $561.79
| Professional | | $292.37 | $488.14 | $561.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.25 / $510.88 / $856.80
| Professional | | $434.25 | $510.88 | $856.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.75 / $618.09 / $1,264.44
| Professional | | $332.75 | $618.09 | $1,264.44 |
- 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
- $440.29 / $602.62 / $924.84
| Professional | | $440.29 | $602.62 | $924.84 |