- 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
- $224.78 / $300.30 / $343.40
| Professional | | $224.78 | $300.30 | $343.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.24 / $366.16 / $557.64
| Professional | | $311.24 | $366.16 | $557.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.46 / $425.00 / $599.39
| Professional | | $236.46 | $425.00 | $599.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.00 / $2,384.00 / $5,510.00
| Facility | | $1,395.00 | $2,384.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.71 / $308.45 / $631.13
| Professional | | $219.71 | $308.45 | $631.13 |