- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $3,706.14 / $6,245.45
| Facility | | $2,090.73 | $3,706.14 | $6,245.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.79 / $254.47 / $575.65
| Professional | | $140.79 | $254.47 | $575.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.09 / $309.37 / $607.91
| Professional | | $173.09 | $309.37 | $607.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $323.85 / $904.74
| Professional | | $150.00 | $323.85 | $904.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $3,447.00 / $7,350.00
| Facility | | $2,654.00 | $3,447.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.48 / $630.36 / $772.70
| Professional | | $350.48 | $630.36 | $772.70 |