- 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
- $318.45 / $337.08 / $456.74
| Professional | | $318.45 | $337.08 | $456.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.53 / $421.80 / $623.04
| Professional | | $358.53 | $421.80 | $623.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.00 / $505.62 / $678.59
| Professional | | $300.00 | $505.62 | $678.59 |
- 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
- $299.80 / $470.38 / $704.86
| Professional | | $299.80 | $470.38 | $704.86 |