- 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
- $323.32 / $331.67 / $448.45
| Professional | | $323.32 | $331.67 | $448.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.30 / $393.29 / $632.79
| Professional | | $334.30 | $393.29 | $632.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $463.07 / $669.23
| Professional | | $150.00 | $463.07 | $669.23 |
- 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
- $334.44 / $460.20 / $707.78
| Professional | | $334.44 | $460.20 | $707.78 |