- 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
- $270.67 / $460.36 / $721.34
| Professional | | $270.67 | $460.36 | $721.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.83 / $421.88 / $755.79
| Professional | | $287.83 | $421.88 | $755.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.64 / $546.11 / $873.17
| Professional | | $390.64 | $546.11 | $873.17 |
- 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
- $368.57 / $608.72 / $940.42
| Professional | | $368.57 | $608.72 | $940.42 |