- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,470.93 / $3,955.04
| Facility | | $2,424.15 | $3,470.93 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.54 / $325.64 / $448.70
| Professional | | $285.54 | $325.64 | $448.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.00 / $448.39 / $594.35
| Professional | | $334.00 | $448.39 | $594.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.44 / $510.00 / $714.46
| Professional | | $328.44 | $510.00 | $714.46 |
- 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
- $315.64 / $495.24 / $755.04
| Professional | | $315.64 | $495.24 | $755.04 |