- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,223.06 / $1,223.06 / $11,211.00
| Facility | | $1,223.06 | $1,223.06 | $11,211.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.19 / $475.90 / $485.20
| Professional | | $468.19 | $475.90 | $485.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.81 / $594.70 / $824.27
| Professional | | $424.81 | $594.70 | $824.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,079.13 / $6,079.13 / $7,712.83
| Facility | | $6,079.13 | $6,079.13 | $7,712.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.07 / $602.44 / $1,078.13
| Professional | | $466.07 | $602.44 | $1,078.13 |