- 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
- $305.20 / $394.30 / $476.12
| Professional | | $305.20 | $394.30 | $476.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.37 / $455.87 / $613.23
| Professional | | $329.37 | $455.87 | $613.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.60 / $537.66 / $702.19
| Professional | | $411.60 | $537.66 | $702.19 |
- 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
- $278.16 / $486.73 / $748.00
| Professional | | $278.16 | $486.73 | $748.00 |