- 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
- $130.33 / $143.56 / $189.42
| Professional | | $130.33 | $143.56 | $189.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.16 / $212.30 / $249.77
| Professional | | $155.16 | $212.30 | $249.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.49 / $224.98 / $328.02
| Professional | | $150.49 | $224.98 | $328.02 |
- 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
- $144.91 / $197.48 / $298.36
| Professional | | $144.91 | $197.48 | $298.36 |