- 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
- $86.62 / $128.09 / $196.57
| Professional | | $86.62 | $128.09 | $196.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.46 / $209.88 / $212.69
| Professional | | $132.46 | $209.88 | $212.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.22 / $167.14 / $355.01
| Professional | | $92.22 | $167.14 | $355.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,052.00 / $5,510.00
| Facility | | $1,812.00 | $4,052.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.02 / $175.29 / $260.35
| Professional | | $114.02 | $175.29 | $260.35 |