- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,958.18 / $4,611.50 / $7,256.82
| Facility | | $2,958.18 | $4,611.50 | $7,256.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.57 / $236.25 / $324.41
| Professional | | $157.57 | $236.25 | $324.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.51 / $302.83 / $3,436.14
| Facility | | $157.51 | $302.83 | $3,436.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.62 / $351.27 / $1,791.04
| Professional | | $222.62 | $351.27 | $1,791.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.43 / $265.86 / $402.99
| Professional | | $173.43 | $265.86 | $402.99 |