- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,379.86 / $1,543.03 / $3,955.04
| Facility | | $1,379.86 | $1,543.03 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.32 / $332.79 / $524.47
| Professional | | $239.32 | $332.79 | $524.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.20 / $382.66 / $661.72
| Professional | | $270.20 | $382.66 | $661.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.54 / $511.84 / $718.76
| Professional | | $356.54 | $511.84 | $718.76 |
- 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
- $313.35 / $517.52 / $777.11
| Professional | | $313.35 | $517.52 | $777.11 |