- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $1,655.27 / $3,955.04
| Facility | | $1,518.41 | $1,655.27 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.43 / $127.94 / $192.28
| Professional | | $112.43 | $127.94 | $192.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $388.81 / $388.81
| Professional | | $0.02 | $388.81 | $388.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.46 / $207.69 / $260.64
| Professional | | $151.46 | $207.69 | $260.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,299.00 / $4,374.00 / $9,622.00
| Facility | | $2,299.00 | $4,374.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.43 / $180.67 / $276.27
| Professional | | $110.43 | $180.67 | $276.27 |