- 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
- $158.49 / $676.08 / $2,454.71
| Professional | | $158.49 | $676.08 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $389.05 / $2,398.83
| Professional | | $181.97 | $389.05 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $512.86 / $4,265.80
| Professional | | $158.49 | $512.86 | $4,265.80 |
- 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
- $223.87 / $1,479.11 / $3,235.94
| Professional | | $223.87 | $1,479.11 | $3,235.94 |