- 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
- $265.37 / $316.43 / $380.76
| Professional | | $265.37 | $316.43 | $380.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.73 / $404.02 / $559.17
| Professional | | $283.73 | $404.02 | $559.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.88 / $434.55 / $797.19
| Professional | | $336.88 | $434.55 | $797.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,080.00 / $3,447.00 / $7,350.00
| Facility | | $2,080.00 | $3,447.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.11 / $492.03 / $734.34
| Professional | | $296.11 | $492.03 | $734.34 |