- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,993.72 / $3,706.14 / $3,955.04
| Facility | | $2,993.72 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.93 / $129.41 / $135.43
| Professional | | $97.93 | $129.41 | $135.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.33 / $142.74 / $242.08
| Professional | | $121.33 | $142.74 | $242.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.88 / $195.16 / $281.22
| Professional | | $90.88 | $195.16 | $281.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $3,447.00 / $7,350.00
| Facility | | $2,654.00 | $3,447.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.38 / $136.40 / $259.82
| Professional | | $103.38 | $136.40 | $259.82 |