- 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
- $178.76 / $311.56 / $455.54
| Professional | | $178.76 | $311.56 | $455.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.44 / $437.50 / $589.12
| Professional | | $316.44 | $437.50 | $589.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.86 / $532.91 / $824.11
| Professional | | $213.86 | $532.91 | $824.11 |
- 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
- $366.21 / $507.73 / $809.30
| Professional | | $366.21 | $507.73 | $809.30 |