- 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
- $490.77 / $685.23 / $796.17
| Professional | | $490.77 | $685.23 | $796.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.30 / $652.32 / $1,020.21
| Professional | | $471.30 | $652.32 | $1,020.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.49 / $847.01 / $1,099.42
| Professional | | $679.49 | $847.01 | $1,099.42 |
- 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
- $437.14 / $685.70 / $1,157.31
| Professional | | $437.14 | $685.70 | $1,157.31 |