- 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
- $319.08 / $467.86 / $738.12
| Professional | | $319.08 | $467.86 | $738.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.09 / $469.64 / $881.69
| Professional | | $341.09 | $469.64 | $881.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.07 / $633.76 / $953.19
| Professional | | $445.07 | $633.76 | $953.19 |
- 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
- $412.64 / $673.14 / $1,011.85
| Professional | | $412.64 | $673.14 | $1,011.85 |