- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,598.33 / $2,778.87 / $3,955.04
| Facility | | $1,598.33 | $2,778.87 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.72 / $244.02 / $323.81
| Professional | | $165.72 | $244.02 | $323.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.56 / $311.39 / $492.09
| Professional | | $194.56 | $311.39 | $492.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.67 / $376.22 / $703.28
| Professional | | $236.67 | $376.22 | $703.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,049.00 / $5,510.00
| Facility | | $1,812.00 | $4,049.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.66 / $433.81 / $752.74
| Professional | | $282.66 | $433.81 | $752.74 |