- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $1,543.03 / $3,955.04
| Facility | | $1,518.41 | $1,543.03 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.16 / $116.23 / $152.69
| Professional | | $79.16 | $116.23 | $152.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.33 / $128.32 / $200.41
| Professional | | $92.33 | $128.32 | $200.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.47 / $174.89 / $233.97
| Professional | | $120.47 | $174.89 | $233.97 |
- 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
- $101.26 / $163.08 / $256.54
| Professional | | $101.26 | $163.08 | $256.54 |