- 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
- $239.81 / $484.26 / $507.22
| Professional | | $239.81 | $484.26 | $507.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.61 / $554.84 / $698.10
| Professional | | $471.61 | $554.84 | $698.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.38 / $520.78 / $966.94
| Professional | | $418.38 | $520.78 | $966.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $4,086.00 / $9,622.00
| Facility | | $3,146.00 | $4,086.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.18 / $582.62 / $948.22
| Professional | | $372.18 | $582.62 | $948.22 |