- 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
- $238.14 / $500.03 / $591.12
| Professional | | $238.14 | $500.03 | $591.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.07 / $288.32 / $960.59
| Professional | | $245.07 | $288.32 | $960.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.26 / $419.62 / $692.91
| Professional | | $180.26 | $419.62 | $692.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $2,517.00 / $4,602.00
| Facility | | $1,388.00 | $2,517.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.65 / $531.29 / $822.95
| Professional | | $377.65 | $531.29 | $822.95 |