- 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
- $323.52 / $431.27 / $629.84
| Professional | | $323.52 | $431.27 | $629.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.35 / $442.01 / $778.71
| Professional | | $319.35 | $442.01 | $778.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.84 / $612.78 / $759.03
| Professional | | $443.84 | $612.78 | $759.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.00 / $1,401.00 / $4,915.00
| Facility | | $437.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.86 / $526.14 / $811.80
| Professional | | $327.86 | $526.14 | $811.80 |