- 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
- $160.68 / $211.26 / $236.80
| Professional | | $160.68 | $211.26 | $236.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.06 / $228.31 / $389.12
| Professional | | $194.06 | $228.31 | $389.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.53 / $221.79 / $394.75
| Professional | | $151.53 | $221.79 | $394.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $5,164.00 / $9,622.00
| Facility | | $3,146.00 | $5,164.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.80 / $201.21 / $302.97
| Professional | | $175.80 | $201.21 | $302.97 |