- 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
- $231.18 / $278.80 / $403.21
| Professional | | $231.18 | $278.80 | $403.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.50 / $327.64 / $515.84
| Professional | | $247.50 | $327.64 | $515.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.85 / $428.19 / $555.15
| Professional | | $324.85 | $428.19 | $555.15 |
- 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
- $232.90 / $384.81 / $595.15
| Professional | | $232.90 | $384.81 | $595.15 |