- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,706.14 / $5,294.16
| Facility | | $2,424.15 | $3,706.14 | $5,294.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.18 / $271.67 / $366.44
| Professional | | $264.18 | $271.67 | $366.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.00 / $322.35 / $518.61
| Professional | | $274.00 | $322.35 | $518.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $373.88 / $548.47
| Professional | | $150.00 | $373.88 | $548.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $3,447.00 / $7,350.00
| Facility | | $2,654.00 | $3,447.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.70 / $377.10 / $580.00
| Professional | | $272.70 | $377.10 | $580.00 |