- 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
- $177.54 / $222.27 / $285.83
| Professional | | $177.54 | $222.27 | $285.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.95 / $281.35 / $364.03
| Professional | | $196.95 | $281.35 | $364.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $316.77 / $451.35
| Professional | | $150.00 | $316.77 | $451.35 |
- 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
- $199.40 / $312.86 / $483.93
| Professional | | $199.40 | $312.86 | $483.93 |