- 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
- $293.22 / $439.74 / $710.11
| Professional | | $293.22 | $439.74 | $710.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.44 / $465.11 / $845.70
| Professional | | $320.44 | $465.11 | $845.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.21 / $602.59 / $964.01
| Professional | | $431.21 | $602.59 | $964.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,049.00 / $5,510.00
| Facility | | $1,812.00 | $4,049.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.57 / $674.49 / $1,040.38
| Professional | | $398.57 | $674.49 | $1,040.38 |