- 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
- $145.63 / $188.23 / $247.17
| Professional | | $145.63 | $188.23 | $247.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.38 / $248.38 / $374.29
| Professional | | $159.38 | $248.38 | $374.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.39 / $324.57 / $525.72
| Professional | | $215.39 | $324.57 | $525.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,569.00 / $4,571.00 / $7,350.00
| Facility | | $2,569.00 | $4,571.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.84 / $277.70 / $467.58
| Professional | | $162.84 | $277.70 | $467.58 |