- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,955.04 / $4,600.62
| Facility | | $2,424.15 | $3,955.04 | $4,600.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.48 / $101.44 / $136.36
| Professional | | $81.48 | $101.44 | $136.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.83 / $156.47 / $187.98
| Professional | | $117.83 | $156.47 | $187.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.29 / $170.15 / $280.52
| Professional | | $113.29 | $170.15 | $280.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $4,086.00 / $10,355.75
| Facility | | $3,146.00 | $4,086.00 | $10,355.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.17 / $130.63 / $306.81
| Professional | | $108.17 | $130.63 | $306.81 |