- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.72 / $2,778.87 / $3,955.04
| Facility | | $382.72 | $2,778.87 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.14 / $585.92 / $821.10
| Professional | | $124.14 | $585.92 | $821.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.98 / $237.86 / $928.08
| Professional | | $116.98 | $237.86 | $928.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.57 / $284.06 / $1,271.02
| Professional | | $160.57 | $284.06 | $1,271.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $2,445.00 / $4,602.00
| Facility | | $1,388.00 | $2,445.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.01 / $881.04 / $1,369.47
| Professional | | $478.01 | $881.04 | $1,369.47 |