- 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
- $129.44 / $206.50 / $293.31
| Professional | | $129.44 | $206.50 | $293.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.82 / $165.83 / $383.11
| Professional | | $119.82 | $165.83 | $383.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.74 / $315.26 / $361.23
| Professional | | $172.74 | $315.26 | $361.23 |
- 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
- $132.90 / $231.24 / $320.85
| Professional | | $132.90 | $231.24 | $320.85 |