- 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
- $158.59 / $234.87 / $409.93
| Professional | | $158.59 | $234.87 | $409.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.70 / $326.95 / $476.77
| Professional | | $196.70 | $326.95 | $476.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.61 / $332.71 / $632.80
| Professional | | $162.61 | $332.71 | $632.80 |
- 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
- $316.87 / $398.38 / $622.37
| Professional | | $316.87 | $398.38 | $622.37 |