- 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
- $486.20 / $529.79 / $584.54
| Professional | | $486.20 | $529.79 | $584.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.95 / $628.17 / $908.39
| Professional | | $533.95 | $628.17 | $908.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.58 / $623.88 / $1,120.02
| Professional | | $397.58 | $623.88 | $1,120.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $2,517.00 / $4,602.00
| Facility | | $1,388.00 | $2,517.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.01 / $533.65 / $824.98
| Professional | | $380.01 | $533.65 | $824.98 |