- 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
- $455.97 / $470.72 / $623.36
| Professional | | $455.97 | $470.72 | $623.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.17 / $562.54 / $886.09
| Professional | | $478.17 | $562.54 | $886.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $616.61 / $946.87
| Professional | | $150.00 | $616.61 | $946.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,838.00 / $4,086.00 / $7,409.00
| Facility | | $2,838.00 | $4,086.00 | $7,409.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.60 / $646.22 / $995.38
| Professional | | $442.60 | $646.22 | $995.38 |