- 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
- $168.17 / $192.86 / $369.14
| Professional | | $168.17 | $192.86 | $369.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.03 / $324.10 / $388.60
| Professional | | $197.03 | $324.10 | $388.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.05 / $299.70 / $676.18
| Professional | | $138.05 | $299.70 | $676.18 |
- 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
- $229.34 / $406.28 / $502.47
| Professional | | $229.34 | $406.28 | $502.47 |