- 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
- $237.62 / $381.74 / $604.47
| Professional | | $237.62 | $381.74 | $604.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.56 / $416.77 / $673.14
| Professional | | $252.56 | $416.77 | $673.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.67 / $504.62 / $788.02
| Professional | | $313.67 | $504.62 | $788.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,049.00 / $5,510.00
| Facility | | $1,812.00 | $4,049.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.35 / $553.03 / $846.34
| Professional | | $342.35 | $553.03 | $846.34 |