- 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
- $354.52 / $482.10 / $617.45
| Professional | | $354.52 | $482.10 | $617.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.43 / $494.04 / $790.41
| Professional | | $386.43 | $494.04 | $790.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.36 / $633.20 / $848.63
| Professional | | $510.36 | $633.20 | $848.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.00 / $1,401.00 / $4,915.00
| Facility | | $437.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.12 / $604.66 / $932.69
| Professional | | $346.12 | $604.66 | $932.69 |