- 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
- $283.80 / $412.06 / $623.91
| Professional | | $283.80 | $412.06 | $623.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.25 / $474.64 / $728.42
| Professional | | $332.25 | $474.64 | $728.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.35 / $531.86 / $907.13
| Professional | | $241.35 | $531.86 | $907.13 |
- 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
- $326.48 / $590.66 / $905.91
| Professional | | $326.48 | $590.66 | $905.91 |