- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $3,706.14 / $4,892.58
| Facility | | $1,518.41 | $3,706.14 | $4,892.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.38 / $144.84 / $251.74
| Professional | | $67.38 | $144.84 | $251.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.01 / $196.64 / $272.16
| Professional | | $87.01 | $196.64 | $272.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.42 / $182.34 / $435.89
| Professional | | $118.42 | $182.34 | $435.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $2,445.00 / $4,602.00
| Facility | | $1,388.00 | $2,445.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.03 / $269.20 / $463.31
| Professional | | $177.03 | $269.20 | $463.31 |