- 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
- $180.71 / $253.53 / $567.87
| Professional | | $180.71 | $253.53 | $567.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.58 / $308.31 / $484.81
| Professional | | $177.58 | $308.31 | $484.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.57 / $275.57 / $275.57
| Professional | | $275.57 | $275.57 | $275.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,183.00 / $4,915.00
| Facility | | $540.00 | $1,183.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.27 / $698.40 / $920.26
| Professional | | $441.27 | $698.40 | $920.26 |