- 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
- $339.80 / $471.85 / $545.32
| Professional | | $339.80 | $471.85 | $545.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.90 / $453.85 / $696.32
| Professional | | $327.90 | $453.85 | $696.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.76 / $723.62 / $778.83
| Professional | | $472.76 | $723.62 | $778.83 |
- 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
- $304.05 / $507.00 / $768.90
| Professional | | $304.05 | $507.00 | $768.90 |