- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.06 / $1,543.03 / $3,955.04
| Facility | | $972.06 | $1,543.03 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.44 / $437.30 / $629.50
| Professional | | $358.44 | $437.30 | $629.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.57 / $476.48 / $807.64
| Professional | | $373.57 | $476.48 | $807.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.78 / $673.57 / $864.15
| Professional | | $517.78 | $673.57 | $864.15 |
- 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
- $337.79 / $541.62 / $897.22
| Professional | | $337.79 | $541.62 | $897.22 |