- 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
- $163.37 / $226.16 / $234.06
| Professional | | $163.37 | $226.16 | $234.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.48 / $247.62 / $405.43
| Professional | | $210.48 | $247.62 | $405.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.11 / $311.92 / $425.00
| Professional | | $163.11 | $311.92 | $425.00 |
- 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
- $153.16 / $289.63 / $448.16
| Professional | | $153.16 | $289.63 | $448.16 |