- 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
- $353.61 / $498.32 / $584.22
| Professional | | $353.61 | $498.32 | $584.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $408.49 / $408.49
| Professional | | $0.02 | $408.49 | $408.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.97 / $620.34 / $807.70
| Professional | | $355.97 | $620.34 | $807.70 |
- 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
- $281.80 / $531.37 / $860.16
| Professional | | $281.80 | $531.37 | $860.16 |