- 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
- $400.01 / $410.16 / $594.47
| Professional | | $400.01 | $410.16 | $594.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.22 / $495.55 / $822.81
| Professional | | $421.22 | $495.55 | $822.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $544.33 / $847.22
| Professional | | $150.00 | $544.33 | $847.22 |
- 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
- $373.20 / $566.59 / $872.91
| Professional | | $373.20 | $566.59 | $872.91 |