- 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
- $122.19 / $154.38 / $199.53
| Professional | | $122.19 | $154.38 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.62 / $178.02 / $235.40
| Professional | | $128.62 | $178.02 | $235.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.15 / $196.98 / $269.11
| Professional | | $172.15 | $196.98 | $269.11 |
- 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
- $103.56 / $186.54 / $267.04
| Professional | | $103.56 | $186.54 | $267.04 |