- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $3,955.04 / $5,240.91
| Facility | | $1,518.41 | $3,955.04 | $5,240.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.51 / $238.40 / $395.67
| Professional | | $147.51 | $238.40 | $395.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.60 / $258.70 / $426.89
| Professional | | $158.60 | $258.70 | $426.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.72 / $320.77 / $541.48
| Professional | | $219.72 | $320.77 | $541.48 |
- 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
- $201.64 / $375.34 / $581.67
| Professional | | $201.64 | $375.34 | $581.67 |