- 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
- $89.63 / $121.49 / $169.94
| Professional | | $89.63 | $121.49 | $169.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.78 / $170.87 / $208.01
| Professional | | $106.78 | $170.87 | $208.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.15 / $179.28 / $331.81
| Professional | | $103.15 | $179.28 | $331.81 |
- 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
- $129.46 / $189.50 / $344.34
| Professional | | $129.46 | $189.50 | $344.34 |