- 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
- $139.37 / $333.54 / $675.08
| Professional | | $139.37 | $333.54 | $675.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.78 / $345.53 / $622.69
| Professional | | $154.78 | $345.53 | $622.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.85 / $302.79 / $837.42
| Professional | | $214.85 | $302.79 | $837.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,569.00 / $4,571.00 / $7,350.00
| Facility | | $2,569.00 | $4,571.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.56 / $580.47 / $905.15
| Professional | | $345.56 | $580.47 | $905.15 |