- 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
- $396.08 / $406.38 / $539.75
| Professional | | $396.08 | $406.38 | $539.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.20 / $489.65 / $768.12
| Professional | | $416.20 | $489.65 | $768.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $545.02 / $813.04
| Professional | | $150.00 | $545.02 | $813.04 |
- 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
- $327.08 / $561.49 / $864.96
| Professional | | $327.08 | $561.49 | $864.96 |