- 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
- $236.52 / $300.33 / $459.23
| Professional | | $236.52 | $300.33 | $459.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.51 / $503.83 / $835.08
| Professional | | $328.51 | $503.83 | $835.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.64 / $581.52 / $783.28
| Professional | | $272.64 | $581.52 | $783.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,069.00 / $1,788.00 / $4,602.00
| Facility | | $1,069.00 | $1,788.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.16 / $542.94 / $821.49
| Professional | | $353.16 | $542.94 | $821.49 |