- 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
- $173.06 / $217.59 / $330.72
| Professional | | $173.06 | $217.59 | $330.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.30 / $223.79 / $438.04
| Professional | | $184.30 | $223.79 | $438.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.68 / $311.87 / $430.94
| Professional | | $242.68 | $311.87 | $430.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.00 / $2,445.00 / $4,602.00
| Facility | | $1,334.00 | $2,445.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.07 / $302.50 / $472.45
| Professional | | $189.07 | $302.50 | $472.45 |