- 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
- $326.41 / $359.33 / $363.40
| Professional | | $326.41 | $359.33 | $363.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.67 / $394.91 / $618.98
| Professional | | $335.67 | $394.91 | $618.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.14 / $386.24 / $699.96
| Professional | | $257.14 | $386.24 | $699.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.00 / $1,417.00 / $4,915.00
| Facility | | $437.00 | $1,417.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.03 / $415.32 / $508.71
| Professional | | $235.03 | $415.32 | $508.71 |