- 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
- $153.68 / $235.57 / $361.23
| Professional | | $153.68 | $235.57 | $361.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.03 / $252.84 / $436.85
| Professional | | $163.03 | $252.84 | $436.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.84 / $331.74 / $497.63
| Professional | | $239.84 | $331.74 | $497.63 |
- 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
- $197.58 / $354.87 / $529.83
| Professional | | $197.58 | $354.87 | $529.83 |