- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $3,678.68 / $3,955.04
| Facility | | $2,090.73 | $3,678.68 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.06 / $252.52 / $339.36
| Professional | | $246.06 | $252.52 | $339.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.79 / $299.75 / $480.81
| Professional | | $254.79 | $299.75 | $480.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.49 / $355.32 / $509.90
| Professional | | $211.49 | $355.32 | $509.90 |
- 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
- $253.28 / $350.40 / $538.94
| Professional | | $253.28 | $350.40 | $538.94 |