- 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
- $132.13 / $267.62 / $489.54
| Professional | | $132.13 | $267.62 | $489.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.63 / $294.89 / $468.49
| Professional | | $149.63 | $294.89 | $468.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.36 / $302.16 / $677.06
| Professional | | $188.36 | $302.16 | $677.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $2,445.00 / $4,602.00
| Facility | | $1,388.00 | $2,445.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.72 / $430.81 / $683.67
| Professional | | $275.72 | $430.81 | $683.67 |