- 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
- $282.92 / $438.48 / $684.40
| Professional | | $282.92 | $438.48 | $684.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.05 / $454.25 / $829.06
| Professional | | $314.05 | $454.25 | $829.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.28 / $546.41 / $937.72
| Professional | | $423.28 | $546.41 | $937.72 |
- 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
- $372.85 / $584.86 / $987.24
| Professional | | $372.85 | $584.86 | $987.24 |