- 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
- $136.08 / $158.26 / $249.14
| Professional | | $136.08 | $158.26 | $249.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.77 / $256.39 / $257.43
| Professional | | $156.77 | $256.39 | $257.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.30 / $205.33 / $442.22
| Professional | | $107.30 | $205.33 | $442.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,806.00 / $4,049.00 / $5,510.00
| Facility | | $1,806.00 | $4,049.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.62 / $306.52 / $336.76
| Professional | | $145.62 | $306.52 | $336.76 |