- 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
- $197.28 / $226.54 / $346.60
| Professional | | $197.28 | $226.54 | $346.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.15 / $254.24 / $450.64
| Professional | | $199.15 | $254.24 | $450.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.31 / $370.88 / $481.03
| Professional | | $280.31 | $370.88 | $481.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,080.00 / $3,912.00 / $7,350.00
| Facility | | $2,080.00 | $3,912.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.27 / $337.53 / $511.21
| Professional | | $212.27 | $337.53 | $511.21 |