- 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
- $121.04 / $176.12 / $264.31
| Professional | | $121.04 | $176.12 | $264.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $177.06 / $338.82
| Professional | | $134.90 | $177.06 | $338.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.59 / $235.10 / $362.76
| Professional | | $175.59 | $235.10 | $362.76 |
- 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
- $148.24 / $226.26 / $384.36
| Professional | | $148.24 | $226.26 | $384.36 |