- 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
- $53.07 / $92.73 / $176.47
| Professional | | $53.07 | $92.73 | $176.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.28 / $128.83 / $206.63
| Professional | | $62.28 | $128.83 | $206.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.15 / $138.81 / $303.29
| Professional | | $67.15 | $138.81 | $303.29 |
- 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
- $133.35 / $175.82 / $315.37
| Professional | | $133.35 | $175.82 | $315.37 |