- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $3,706.14 / $6,660.80
| Facility | | $1,518.41 | $3,706.14 | $6,660.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.00 / $229.48 / $302.32
| Professional | | $176.00 | $229.48 | $302.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.51 / $288.56 / $417.35
| Professional | | $185.51 | $288.56 | $417.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.31 / $320.70 / $613.59
| Professional | | $219.31 | $320.70 | $613.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.00 / $2,154.00 / $4,602.00
| Facility | | $1,334.00 | $2,154.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.61 / $380.35 / $658.03
| Professional | | $230.61 | $380.35 | $658.03 |