- 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
- $321.72 / $368.48 / $509.52
| Professional | | $321.72 | $368.48 | $509.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.57 / $459.49 / $728.72
| Professional | | $390.57 | $459.49 | $728.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.00 / $546.71 / $762.43
| Professional | | $300.00 | $546.71 | $762.43 |
- 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
- $327.01 / $528.49 / $766.04
| Professional | | $327.01 | $528.49 | $766.04 |