- 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
- $222.26 / $358.06 / $583.66
| Professional | | $222.26 | $358.06 | $583.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.39 / $371.62 / $635.57
| Professional | | $242.39 | $371.62 | $635.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.88 / $484.32 / $772.81
| Professional | | $343.88 | $484.32 | $772.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,569.00 / $4,628.00 / $7,350.00
| Facility | | $2,569.00 | $4,628.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.85 / $538.16 / $828.30
| Professional | | $325.85 | $538.16 | $828.30 |