- 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
- $366.38 / $505.02 / $639.17
| Professional | | $366.38 | $505.02 | $639.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.34 / $500.71 / $802.09
| Professional | | $392.34 | $500.71 | $802.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.54 / $674.40 / $876.16
| Professional | | $532.54 | $674.40 | $876.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $2,445.00 / $4,602.00
| Facility | | $1,388.00 | $2,445.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.37 / $619.53 / $924.36
| Professional | | $355.37 | $619.53 | $924.36 |