- 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
- $278.86 / $391.95 / $609.22
| Professional | | $278.86 | $391.95 | $609.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.58 / $425.74 / $785.75
| Professional | | $311.58 | $425.74 | $785.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.57 / $523.80 / $836.78
| Professional | | $370.57 | $523.80 | $836.78 |
- 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
- $335.71 / $539.50 / $906.70
| Professional | | $335.71 | $539.50 | $906.70 |