- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $2,962.36 / $5,481.54
| Facility | | $1,518.41 | $2,962.36 | $5,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.92 / $375.39 / $652.50
| Professional | | $183.92 | $375.39 | $652.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.48 / $416.85 / $697.83
| Professional | | $202.48 | $416.85 | $697.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.68 / $462.36 / $861.51
| Professional | | $282.68 | $462.36 | $861.51 |
- 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
- $390.72 / $597.16 / $929.24
| Professional | | $390.72 | $597.16 | $929.24 |