- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $3,706.14 / $4,436.42
| Facility | | $1,518.41 | $3,706.14 | $4,436.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.97 / $398.57 / $556.33
| Professional | | $281.97 | $398.57 | $556.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.15 / $558.79 / $744.55
| Professional | | $391.15 | $558.79 | $744.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.23 / $600.61 / $950.34
| Professional | | $255.23 | $600.61 | $950.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.00 / $2,384.00 / $5,033.00
| Facility | | $1,395.00 | $2,384.00 | $5,033.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.54 / $658.74 / $1,163.83
| Professional | | $399.54 | $658.74 | $1,163.83 |