- 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
- $198.71 / $249.87 / $355.45
| Professional | | $198.71 | $249.87 | $355.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.33 / $263.12 / $454.64
| Professional | | $216.33 | $263.12 | $454.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.10 / $371.77 / $488.64
| Professional | | $279.10 | $371.77 | $488.64 |
- 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
- $213.89 / $342.19 / $515.74
| Professional | | $213.89 | $342.19 | $515.74 |