- 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
- $382.01 / $534.20 / $617.22
| Professional | | $382.01 | $534.20 | $617.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.04 / $509.40 / $792.77
| Professional | | $368.04 | $509.40 | $792.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.63 / $816.78 / $869.03
| Professional | | $530.63 | $816.78 | $869.03 |
- 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
- $371.19 / $594.98 / $899.29
| Professional | | $371.19 | $594.98 | $899.29 |