- 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
- $153.47 / $234.80 / $330.32
| Professional | | $153.47 | $234.80 | $330.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.86 / $353.73 / $453.18
| Professional | | $284.86 | $353.73 | $453.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.34 / $380.74 / $678.25
| Professional | | $174.34 | $380.74 | $678.25 |
- 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
- $283.81 / $470.14 / $728.01
| Professional | | $283.81 | $470.14 | $728.01 |