- 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
- $455.06 / $551.94 / $803.85
| Professional | | $455.06 | $551.94 | $803.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.04 / $600.24 / $1,030.08
| Professional | | $471.04 | $600.24 | $1,030.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.40 / $823.86 / $1,101.39
| Professional | | $648.40 | $823.86 | $1,101.39 |
- 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
- $458.80 / $763.49 / $1,168.51
| Professional | | $458.80 | $763.49 | $1,168.51 |