- 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
- $120.15 / $230.74 / $383.78
| Professional | | $120.15 | $230.74 | $383.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.51 / $258.70 / $376.75
| Professional | | $137.51 | $258.70 | $376.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.78 / $269.73 / $566.35
| Professional | | $176.78 | $269.73 | $566.35 |
- 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
- $216.20 / $370.34 / $569.74
| Professional | | $216.20 | $370.34 | $569.74 |