- 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
- $79.63 / $94.10 / $131.44
| Professional | | $79.63 | $94.10 | $131.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.80 / $143.28 / $177.03
| Professional | | $96.80 | $143.28 | $177.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.64 / $149.56 / $227.27
| Professional | | $89.64 | $149.56 | $227.27 |
- 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
- $100.40 / $143.79 / $246.69
| Professional | | $100.40 | $143.79 | $246.69 |