- 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
- $116.51 / $157.57 / $210.27
| Professional | | $116.51 | $157.57 | $210.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.27 / $179.05 / $291.50
| Professional | | $111.27 | $179.05 | $291.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.08 / $221.54 / $421.15
| Professional | | $136.08 | $221.54 | $421.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.07 / $245.76 / $387.24
| Professional | | $158.07 | $245.76 | $387.24 |