- 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
- $419.06 / $436.42 / $610.72
| Professional | | $419.06 | $436.42 | $610.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.22 / $541.44 / $888.48
| Professional | | $460.22 | $541.44 | $888.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.00 / $584.51 / $886.04
| Professional | | $300.00 | $584.51 | $886.04 |
- 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
- $406.62 / $614.16 / $906.33
| Professional | | $406.62 | $614.16 | $906.33 |