- 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
- $254.28 / $389.17 / $609.09
| Professional | | $254.28 | $389.17 | $609.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.76 / $383.22 / $712.24
| Professional | | $269.76 | $383.22 | $712.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.53 / $514.54 / $791.53
| Professional | | $354.53 | $514.54 | $791.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,569.00 / $4,571.00 / $7,350.00
| Facility | | $2,569.00 | $4,571.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.58 / $554.60 / $864.16
| Professional | | $307.58 | $554.60 | $864.16 |