- 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
- $420.04 / $582.10 / $746.91
| Professional | | $420.04 | $582.10 | $746.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.12 / $558.41 / $955.04
| Professional | | $452.12 | $558.41 | $955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $612.70 / $750.91 / $1,023.64
| Professional | | $612.70 | $750.91 | $1,023.64 |
- 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
- $432.64 / $714.54 / $1,083.36
| Professional | | $432.64 | $714.54 | $1,083.36 |