- 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
- $167.56 / $192.63 / $292.20
| Professional | | $167.56 | $192.63 | $292.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.50 / $306.19 / $327.47
| Professional | | $196.50 | $306.19 | $327.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.62 / $242.14 / $519.39
| Professional | | $137.62 | $242.14 | $519.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,417.00 / $4,915.00
| Facility | | $540.00 | $1,417.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.03 / $298.27 / $377.93
| Professional | | $171.03 | $298.27 | $377.93 |