- 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
- $314.17 / $343.58 / $530.66
| Professional | | $314.17 | $343.58 | $530.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.73 / $562.27 / $609.89
| Professional | | $372.73 | $562.27 | $609.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.54 / $463.16 / $967.45
| Professional | | $245.54 | $463.16 | $967.45 |
- 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
- $318.58 / $496.67 / $720.63
| Professional | | $318.58 | $496.67 | $720.63 |