- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $1,847.75 / $3,955.04
| Facility | | $1,518.41 | $1,847.75 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.49 / $176.64 / $207.39
| Professional | | $123.49 | $176.64 | $207.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.66 / $216.17 / $324.13
| Professional | | $156.66 | $216.17 | $324.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.86 / $266.75 / $378.76
| Professional | | $173.86 | $266.75 | $378.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,069.00 / $1,788.00 / $4,602.00
| Facility | | $1,069.00 | $1,788.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.33 / $262.54 / $405.07
| Professional | | $167.33 | $262.54 | $405.07 |