- 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
- $308.95 / $413.98 / $534.72
| Professional | | $308.95 | $413.98 | $534.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.67 / $423.18 / $700.08
| Professional | | $330.67 | $423.18 | $700.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.84 / $609.23 / $766.20
| Professional | | $424.84 | $609.23 | $766.20 |
- 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
- $304.64 / $537.61 / $797.03
| Professional | | $304.64 | $537.61 | $797.03 |