- 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
- $335.10 / $940.55 / $1,330.77
| Professional | | $335.10 | $940.55 | $1,330.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.98 / $401.15 / $1,846.47
| Professional | | $340.98 | $401.15 | $1,846.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.29 / $448.23 / $818.93
| Professional | | $250.29 | $448.23 | $818.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $2,517.00 / $4,602.00
| Facility | | $1,388.00 | $2,517.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.99 / $578.29 / $1,183.76
| Professional | | $348.99 | $578.29 | $1,183.76 |