- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $2,778.87 / $3,955.04
| Facility | | $2,090.73 | $2,778.87 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.31 / $334.72 / $568.37
| Professional | | $64.31 | $334.72 | $568.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.81 / $143.51 / $369.04
| Professional | | $72.81 | $143.51 | $369.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.07 / $175.70 / $812.18
| Professional | | $101.07 | $175.70 | $812.18 |
- 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
- $377.86 / $625.47 / $983.71
| Professional | | $377.86 | $625.47 | $983.71 |