- 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
- $77.03 / $169.13 / $336.36
| Professional | | $77.03 | $169.13 | $336.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.47 / $210.36 / $420.78
| Professional | | $110.47 | $210.36 | $420.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.14 / $195.25 / $500.08
| Professional | | $63.14 | $195.25 | $500.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,069.00 / $1,788.00 / $4,602.00
| Facility | | $1,069.00 | $1,788.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.37 / $321.75 / $586.54
| Professional | | $267.37 | $321.75 | $586.54 |