- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,993.72 / $3,706.14 / $3,955.04
| Facility | | $2,993.72 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.65 / $454.21 / $504.19
| Professional | | $408.65 | $454.21 | $504.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.39 / $541.63 / $781.02
| Professional | | $460.39 | $541.63 | $781.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.38 / $530.70 / $969.11
| Professional | | $335.38 | $530.70 | $969.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,052.00 / $5,510.00
| Facility | | $1,812.00 | $4,052.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.90 / $462.31 / $705.51
| Professional | | $340.90 | $462.31 | $705.51 |