- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,016.07 / $3,243.94 / $9,647.34
| Facility | | $2,016.07 | $3,243.94 | $9,647.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.15 / $473.05 / $660.41
| Professional | | $369.15 | $473.05 | $660.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.43 / $514.09 / $844.92
| Professional | | $371.43 | $514.09 | $844.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.60 / $626.30 / $831.53
| Professional | | $501.60 | $626.30 | $831.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,569.00 / $4,571.00 / $7,350.00
| Facility | | $2,569.00 | $4,571.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.40 / $569.60 / $892.43
| Professional | | $334.40 | $569.60 | $892.43 |