- 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
- $322.50 / $435.05 / $570.07
| Professional | | $322.50 | $435.05 | $570.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.58 / $439.54 / $726.44
| Professional | | $347.58 | $439.54 | $726.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.01 / $592.51 / $781.26
| Professional | | $454.01 | $592.51 | $781.26 |
- 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
- $340.93 / $546.53 / $824.07
| Professional | | $340.93 | $546.53 | $824.07 |