- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,532.76 / $3,706.14 / $3,955.04
| Facility | | $2,532.76 | $3,706.14 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.71 / $142.28 / $193.95
| Professional | | $105.71 | $142.28 | $193.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.41 / $186.31 / $257.22
| Professional | | $130.41 | $186.31 | $257.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.26 / $190.27 / $322.23
| Professional | | $146.26 | $190.27 | $322.23 |
- 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
- $135.07 / $223.36 / $343.38
| Professional | | $135.07 | $223.36 | $343.38 |