- 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
- $117.51 / $136.65 / $187.68
| Professional | | $117.51 | $136.65 | $187.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.43 / $217.84 / $237.98
| Professional | | $153.43 | $217.84 | $237.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $231.90 / $348.24
| Professional | | $150.00 | $231.90 | $348.24 |
- 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
- $137.90 / $210.74 / $382.53
| Professional | | $137.90 | $210.74 | $382.53 |