- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $3,434.54 / $3,955.04
| Facility | | $2,090.73 | $3,434.54 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.37 / $257.68 / $338.26
| Professional | | $198.37 | $257.68 | $338.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.21 / $328.44 / $475.00
| Professional | | $210.21 | $328.44 | $475.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.61 / $366.89 / $694.60
| Professional | | $249.61 | $366.89 | $694.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,049.00 / $5,510.00
| Facility | | $1,812.00 | $4,049.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.88 / $390.10 / $639.75
| Professional | | $255.88 | $390.10 | $639.75 |