- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.41 / $2,778.87 / $4,483.05
| Facility | | $1,257.41 | $2,778.87 | $4,483.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.38 / $456.70 / $819.84
| Professional | | $190.38 | $456.70 | $819.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.59 / $298.20 / $772.70
| Professional | | $178.59 | $298.20 | $772.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.66 / $543.82 / $962.34
| Professional | | $259.66 | $543.82 | $962.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,569.00 / $4,571.00 / $7,350.00
| Facility | | $2,569.00 | $4,571.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.94 / $683.65 / $1,244.40
| Professional | | $405.94 | $683.65 | $1,244.40 |