- 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
- $143.69 / $157.30 / $205.17
| Professional | | $143.69 | $157.30 | $205.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.19 / $226.35 / $274.60
| Professional | | $164.19 | $226.35 | $274.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.88 / $243.27 / $339.15
| Professional | | $158.88 | $243.27 | $339.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $3,447.00 / $7,350.00
| Facility | | $2,654.00 | $3,447.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.24 / $224.05 / $363.10
| Professional | | $157.24 | $224.05 | $363.10 |