- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,518.41 / $2,662.82 / $3,955.04
| Facility | | $1,518.41 | $2,662.82 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.03 / $191.54 / $355.79
| Professional | | $55.03 | $191.54 | $355.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $179.22 / $350.38
| Professional | | $57.54 | $179.22 | $350.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.17 / $119.55 / $488.71
| Professional | | $83.17 | $119.55 | $488.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,049.00 / $5,510.00
| Facility | | $1,812.00 | $4,049.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.54 / $339.87 / $513.09
| Professional | | $171.54 | $339.87 | $513.09 |