- 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
- $396.36 / $639.66 / $1,039.29
| Professional | | $396.36 | $639.66 | $1,039.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.32 / $707.70 / $917.74
| Professional | | $511.32 | $707.70 | $917.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.46 / $792.16 / $4,387.85
| Professional | | $650.46 | $792.16 | $4,387.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.00 / $4,049.00 / $5,510.00
| Facility | | $1,812.00 | $4,049.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.80 / $916.15 / $2,696.73
| Professional | | $491.80 | $916.15 | $2,696.73 |