- 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
- $248.37 / $297.39 / $385.01
| Professional | | $248.37 | $297.39 | $385.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.70 / $368.60 / $525.76
| Professional | | $237.70 | $368.60 | $525.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.80 / $386.16 / $581.82
| Professional | | $204.80 | $386.16 | $581.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.00 / $2,384.00 / $5,510.00
| Facility | | $1,395.00 | $2,384.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $403.30 / $625.05
| Professional | | $257.04 | $403.30 | $625.05 |