- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,941.66 / $2,778.87 / $7,079.40
| Facility | | $1,941.66 | $2,778.87 | $7,079.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.86 / $281.27 / $386.87
| Professional | | $206.86 | $281.27 | $386.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.70 / $413.97 / $566.54
| Professional | | $300.70 | $413.97 | $566.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.54 / $449.21 / $736.33
| Professional | | $213.54 | $449.21 | $736.33 |
- 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
- $296.95 / $481.73 / $680.59
| Professional | | $296.95 | $481.73 | $680.59 |