- 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
- $100.73 / $165.10 / $238.32
| Professional | | $100.73 | $165.10 | $238.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.62 / $253.90 / $343.87
| Professional | | $153.62 | $253.90 | $343.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.36 / $262.58 / $431.56
| Professional | | $163.36 | $262.58 | $431.56 |
- 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
- $154.63 / $299.14 / $462.94
| Professional | | $154.63 | $299.14 | $462.94 |