- 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
- $165.93 / $236.09 / $288.20
| Professional | | $165.93 | $236.09 | $288.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.74 / $218.64 / $394.77
| Professional | | $175.74 | $218.64 | $394.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.69 / $312.55 / $401.17
| Professional | | $237.69 | $312.55 | $401.17 |
- 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
- $168.37 / $278.08 / $437.33
| Professional | | $168.37 | $278.08 | $437.33 |