- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $1,872.70 / $3,955.04
| Facility | | $1,518.41 | $1,872.70 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.09 / $473.27 / $630.05
| Professional | | $461.09 | $473.27 | $630.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.12 / $569.54 / $894.30
| Professional | | $484.12 | $569.54 | $894.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $624.14 / $948.35
| Professional | | $150.00 | $624.14 | $948.35 |
- 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
- $381.52 / $654.64 / $1,008.32
| Professional | | $381.52 | $654.64 | $1,008.32 |