- 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
- $563.62 / $575.59 / $778.51
| Professional | | $563.62 | $575.59 | $778.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.60 / $684.23 / $1,103.90
| Professional | | $581.60 | $684.23 | $1,103.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.00 / $807.13 / $1,167.60
| Professional | | $350.00 | $807.13 | $1,167.60 |
- 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
- $580.08 / $804.71 / $1,237.14
| Professional | | $580.08 | $804.71 | $1,237.14 |