- 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
- $138.77 / $184.35 / $294.25
| Professional | | $138.77 | $184.35 | $294.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.87 / $191.08 / $309.79
| Professional | | $137.87 | $191.08 | $309.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.24 / $271.49 / $362.99
| Professional | | $182.24 | $271.49 | $362.99 |
- 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
- $161.16 / $252.86 / $408.00
| Professional | | $161.16 | $252.86 | $408.00 |