- 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
- $138.53 / $314.62 / $574.02
| Professional | | $138.53 | $314.62 | $574.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.94 / $303.47 / $570.14
| Professional | | $148.94 | $303.47 | $570.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.97 / $359.15 / $786.87
| Professional | | $215.97 | $359.15 | $786.87 |
- 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
- $320.12 / $537.82 / $821.17
| Professional | | $320.12 | $537.82 | $821.17 |