- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,548.82 / $3,981.07
| Facility | | $1,513.56 | $1,548.82 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $302.00 / $794.33
| Professional | | $234.42 | $302.00 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $309.03 / $501.19
| Professional | | $245.47 | $309.03 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $407.38 / $575.44
| Professional | | $275.42 | $407.38 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,412.54 / $6,456.54
| Facility | | $436.52 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $323.59 / $588.84
| Professional | | $218.78 | $323.59 | $588.84 |