- 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
- $393.69 / $430.63 / $485.40
| Professional | | $393.69 | $430.63 | $485.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.16 / $521.36 / $737.78
| Professional | | $443.16 | $521.36 | $737.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.47 / $513.97 / $929.81
| Professional | | $324.47 | $513.97 | $929.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $4,628.00 / $7,350.00
| Facility | | $2,654.00 | $4,628.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.97 / $442.57 / $682.44
| Professional | | $314.97 | $442.57 | $682.44 |