- 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
- $132.94 / $155.88 / $330.18
| Professional | | $132.94 | $155.88 | $330.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.44 / $260.30 / $348.01
| Professional | | $156.44 | $260.30 | $348.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.30 / $258.33 / $601.01
| Professional | | $107.30 | $258.33 | $601.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,052.00 / $5,510.00
| Facility | | $1,812.00 | $4,052.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.10 / $336.76 / $445.01
| Professional | | $204.10 | $336.76 | $445.01 |