- 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
- $311.32 / $351.82 / $478.31
| Professional | | $311.32 | $351.82 | $478.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.12 / $549.30 / $967.37
| Professional | | $269.12 | $549.30 | $967.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,069.00 / $1,788.00 / $4,602.00
| Facility | | $1,069.00 | $1,788.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.20 / $441.73 / $686.60
| Professional | | $321.20 | $441.73 | $686.60 |