- 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
- $117.37 / $205.32 / $294.73
| Professional | | $117.37 | $205.32 | $294.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.38 / $296.57 / $514.26
| Professional | | $145.38 | $296.57 | $514.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.38 / $250.18 / $532.07
| Professional | | $145.38 | $250.18 | $532.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,069.00 / $2,445.00 / $4,602.00
| Facility | | $1,069.00 | $2,445.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.89 / $317.64 / $517.79
| Professional | | $248.89 | $317.64 | $517.79 |