- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,269.36 / $1,379.86 / $5,865.65
| Facility | | $1,269.36 | $1,379.86 | $5,865.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.06 / $346.94 / $510.24
| Professional | | $309.06 | $346.94 | $510.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.67 / $409.24 / $642.75
| Professional | | $295.67 | $409.24 | $642.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.29 / $561.63 / $698.63
| Professional | | $426.29 | $561.63 | $698.63 |
- 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
- $301.07 / $482.93 / $729.13
| Professional | | $301.07 | $482.93 | $729.13 |