- 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
- $238.03 / $299.98 / $396.47
| Professional | | $238.03 | $299.98 | $396.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.47 / $403.45 / $551.91
| Professional | | $284.47 | $403.45 | $551.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.18 / $425.10 / $804.35
| Professional | | $296.18 | $425.10 | $804.35 |
- 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
- $322.77 / $461.48 / $828.40
| Professional | | $322.77 | $461.48 | $828.40 |