- 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
- $297.01 / $533.82 / $870.56
| Professional | | $297.01 | $533.82 | $870.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.41 / $685.01 / $949.16
| Professional | | $348.41 | $685.01 | $949.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.20 / $806.11 / $1,202.02
| Professional | | $486.20 | $806.11 | $1,202.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,080.00 / $3,912.00 / $7,350.00
| Facility | | $2,080.00 | $3,912.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.89 / $899.86 / $1,473.96
| Professional | | $554.89 | $899.86 | $1,473.96 |