- 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
- $411.54 / $457.29 / $535.44
| Professional | | $411.54 | $457.29 | $535.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.30 / $510.94 / $792.62
| Professional | | $434.30 | $510.94 | $792.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $561.71 / $849.18
| Professional | | $150.00 | $561.71 | $849.18 |
- 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
- $371.61 / $583.05 / $898.78
| Professional | | $371.61 | $583.05 | $898.78 |