- 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
- $151.44 / $278.94 / $379.65
| Professional | | $151.44 | $278.94 | $379.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.05 / $368.65 / $689.59
| Professional | | $175.05 | $368.65 | $689.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.05 / $326.72 / $689.45
| Professional | | $175.05 | $326.72 | $689.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.51 / $394.73 / $615.28
| Professional | | $322.51 | $394.73 | $615.28 |