- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $3,706.14 / $8,974.87
| Facility | | $2,090.73 | $3,706.14 | $8,974.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.97 / $522.75 / $817.61
| Professional | | $184.97 | $522.75 | $817.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.23 / $292.50 / $723.89
| Professional | | $174.23 | $292.50 | $723.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.30 / $528.10 / $919.91
| Professional | | $253.30 | $528.10 | $919.91 |
- 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
- $393.93 / $664.31 / $1,190.71
| Professional | | $393.93 | $664.31 | $1,190.71 |