- 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
- $181.97 / $660.69 / $2,344.23
| Professional | | $181.97 | $660.69 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $912.01 / $2,187.76
| Professional | | $162.18 | $912.01 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $416.87 / $4,073.80
| Professional | | $147.91 | $416.87 | $4,073.80 |
- 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
- $194.98 / $1,445.44 / $3,090.30
| Professional | | $194.98 | $1,445.44 | $3,090.30 |