- 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
- $87.01 / $121.49 / $134.86
| Professional | | $87.01 | $121.49 | $134.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.81 / $144.47 / $214.37
| Professional | | $122.81 | $144.47 | $214.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.49 / $143.32 / $257.83
| Professional | | $91.49 | $143.32 | $257.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,052.00 / $5,510.00
| Facility | | $1,812.00 | $4,052.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.86 / $126.09 / $211.04
| Professional | | $80.86 | $126.09 | $211.04 |