- 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
- $544.12 / $586.35 / $687.76
| Professional | | $544.12 | $586.35 | $687.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.54 / $652.41 / $1,060.45
| Professional | | $554.54 | $652.41 | $1,060.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.00 / $715.64 / $1,129.32
| Professional | | $300.00 | $715.64 | $1,129.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,069.00 / $1,788.00 / $4,602.00
| Facility | | $1,069.00 | $1,788.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.02 / $747.50 / $1,148.35
| Professional | | $355.02 | $747.50 | $1,148.35 |