- 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
- $350.67 / $474.67 / $597.14
| Professional | | $350.67 | $474.67 | $597.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.78 / $473.29 / $764.53
| Professional | | $369.78 | $473.29 | $764.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.84 / $625.27 / $817.33
| Professional | | $500.84 | $625.27 | $817.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.27 / $522.98 / $867.27
| Professional | | $313.27 | $522.98 | $867.27 |