- 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
- $318.24 / $423.30 / $502.53
| Professional | | $318.24 | $423.30 | $502.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.35 / $447.54 / $638.35
| Professional | | $323.35 | $447.54 | $638.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.43 / $547.49 / $706.26
| Professional | | $443.43 | $547.49 | $706.26 |
- 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
- $271.80 / $489.56 / $746.65
| Professional | | $271.80 | $489.56 | $746.65 |