- 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
- $412.20 / $423.53 / $560.33
| Professional | | $412.20 | $423.53 | $560.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.63 / $511.33 / $798.80
| Professional | | $434.63 | $511.33 | $798.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.00 / $561.82 / $849.81
| Professional | | $300.00 | $561.82 | $849.81 |
- 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
- $406.52 / $584.98 / $901.30
| Professional | | $406.52 | $584.98 | $901.30 |