- 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
- $192.52 / $228.02 / $303.68
| Professional | | $192.52 | $228.02 | $303.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.24 / $286.06 / $365.07
| Professional | | $200.24 | $286.06 | $365.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.29 / $326.98 / $462.63
| Professional | | $165.29 | $326.98 | $462.63 |
- 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
- $210.06 / $321.95 / $457.87
| Professional | | $210.06 | $321.95 | $457.87 |