- 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
- $134.22 / $157.15 / $243.20
| Professional | | $134.22 | $157.15 | $243.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.12 / $178.64 / $310.30
| Professional | | $143.12 | $178.64 | $310.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.46 / $254.88 / $336.71
| Professional | | $198.46 | $254.88 | $336.71 |
- 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
- $133.88 / $233.40 / $352.01
| Professional | | $133.88 | $233.40 | $352.01 |