- 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
- $190.04 / $214.24 / $293.19
| Professional | | $190.04 | $214.24 | $293.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.27 / $265.77 / $372.65
| Professional | | $196.27 | $265.77 | $372.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.37 / $300.67 / $428.69
| Professional | | $184.37 | $300.67 | $428.69 |
- 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
- $200.06 / $298.33 / $420.11
| Professional | | $200.06 | $298.33 | $420.11 |