- 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
- $331.24 / $362.29 / $542.76
| Professional | | $331.24 | $362.29 | $542.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.38 / $575.47 / $639.04
| Professional | | $392.38 | $575.47 | $639.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.74 / $473.05 / $986.51
| Professional | | $260.74 | $473.05 | $986.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $4,628.00 / $7,350.00
| Facility | | $2,654.00 | $4,628.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.39 / $492.62 / $735.57
| Professional | | $352.39 | $492.62 | $735.57 |