- 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
- $106.57 / $156.35 / $186.92
| Professional | | $106.57 | $156.35 | $186.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.88 / $194.59 / $264.57
| Professional | | $155.88 | $194.59 | $264.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.27 / $173.39 / $335.91
| Professional | | $108.27 | $173.39 | $335.91 |
- 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
- $120.50 / $222.43 / $284.91
| Professional | | $120.50 | $222.43 | $284.91 |