- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $3,706.14 / $4,483.05
| Facility | | $1,518.41 | $3,706.14 | $4,483.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.78 / $234.93 / $404.63
| Professional | | $132.78 | $234.93 | $404.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.43 / $253.48 / $391.12
| Professional | | $152.43 | $253.48 | $391.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.97 / $296.19 / $515.79
| Professional | | $212.97 | $296.19 | $515.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,838.00 / $5,111.00 / $9,622.00
| Facility | | $2,838.00 | $5,111.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.50 / $386.06 / $630.23
| Professional | | $213.50 | $386.06 | $630.23 |