- 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
- $120.96 / $220.23 / $317.92
| Professional | | $120.96 | $220.23 | $317.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.47 / $305.07 / $553.72
| Professional | | $149.47 | $305.07 | $553.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.47 / $261.00 / $571.29
| Professional | | $149.47 | $261.00 | $571.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,069.00 / $2,445.00 / $4,602.00
| Facility | | $1,069.00 | $2,445.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.85 / $340.64 / $718.18
| Professional | | $276.85 | $340.64 | $718.18 |