- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,372.06 / $2,372.06 / $3,572.69
| Facility | | $2,372.06 | $2,372.06 | $3,572.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.05 / $253.65 / $554.79
| Professional | | $246.05 | $253.65 | $554.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.44 / $360.25 / $631.67
| Facility | | $237.44 | $360.25 | $631.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.31 / $1,658.51 / $3,441.60
| Facility | | $405.31 | $1,658.51 | $3,441.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.10 / $254.82 / $6,068.72
| Professional | | $243.10 | $254.82 | $6,068.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.00 / $1,749.00 / $3,367.00
| Facility | | $563.00 | $1,749.00 | $3,367.00 |