- 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
- $275.88 / $431.54 / $596.96
| Professional | | $275.88 | $431.54 | $596.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.18 / $536.46 / $678.85
| Professional | | $334.18 | $536.46 | $678.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.45 / $564.66 / $955.81
| Professional | | $235.45 | $564.66 | $955.81 |
- 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
- $407.38 / $662.53 / $1,116.05
| Professional | | $407.38 | $662.53 | $1,116.05 |