- 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
- $545.64 / $709.30 / $984.70
| Professional | | $545.64 | $709.30 | $984.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.22 / $530.41 / $670.44
| Professional | | $383.22 | $530.41 | $670.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.89 / $936.98 / $1,251.65
| Professional | | $750.89 | $936.98 | $1,251.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,838.00 / $5,111.00 / $9,622.00
| Facility | | $2,838.00 | $5,111.00 | $9,622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.74 / $505.65 / $914.76
| Professional | | $290.74 | $505.65 | $914.76 |