- 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
- $54.40 / $174.62 / $533.92
| Professional | | $54.40 | $174.62 | $533.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.24 / $1,762.31 / $2,012.55
| Facility | | $1,277.24 | $1,762.31 | $2,012.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.53 / $191.74 / $191.74
| Professional | | $138.53 | $191.74 | $191.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $2,445.00 / $4,602.00
| Facility | | $1,388.00 | $2,445.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.79 / $250.69 / $393.25
| Professional | | $151.79 | $250.69 | $393.25 |