- 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
- $263.06 / $320.02 / $473.54
| Professional | | $263.06 | $320.02 | $473.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.58 / $358.63 / $608.17
| Professional | | $283.58 | $358.63 | $608.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.93 / $499.54 / $648.82
| Professional | | $371.93 | $499.54 | $648.82 |
- 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
- $272.31 / $417.65 / $718.02
| Professional | | $272.31 | $417.65 | $718.02 |