- 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
- $77.04 / $190.35 / $352.03
| Professional | | $77.04 | $190.35 | $352.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.49 / $197.06 / $328.53
| Professional | | $86.49 | $197.06 | $328.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.55 / $168.65 / $437.42
| Professional | | $120.55 | $168.65 | $437.42 |
- 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
- $190.64 / $303.20 / $472.46
| Professional | | $190.64 | $303.20 | $472.46 |