- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,548.82 / $3,981.07
| Facility | | $1,513.56 | $1,548.82 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $407.38 / $831.76
| Professional | | $302.00 | $407.38 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $354.81 / $630.96
| Professional | | $263.03 | $354.81 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $489.78 / $831.76
| Professional | | $302.00 | $489.78 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,412.54 / $6,456.54
| Facility | | $436.52 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $446.68 / $741.31
| Professional | | $288.40 | $446.68 | $741.31 |