- 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
- $143.81 / $208.33 / $369.46
| Professional | | $143.81 | $208.33 | $369.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.76 / $354.35 / $388.97
| Professional | | $216.76 | $354.35 | $388.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.72 / $313.82 / $664.47
| Professional | | $151.72 | $313.82 | $664.47 |
- 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
- $225.21 / $335.19 / $487.34
| Professional | | $225.21 | $335.19 | $487.34 |