- 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
- $277.37 / $341.93 / $501.61
| Professional | | $277.37 | $341.93 | $501.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.39 / $384.06 / $643.16
| Professional | | $300.39 | $384.06 | $643.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.55 / $527.01 / $687.88
| Professional | | $393.55 | $527.01 | $687.88 |
- 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
- $274.14 / $477.94 / $729.58
| Professional | | $274.14 | $477.94 | $729.58 |