- 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
- $170.46 / $180.87 / $184.47
| Professional | | $170.46 | $180.87 | $184.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.78 / $128.35 / $183.36
| Professional | | $66.78 | $128.35 | $183.36 |
- 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
- $174.94 / $295.10 / $591.13
| Professional | | $174.94 | $295.10 | $591.13 |