- 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
- $635.62 / $723.82 / $828.56
| Professional | | $635.62 | $723.82 | $828.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.01 / $872.95 / $1,240.55
| Professional | | $742.01 | $872.95 | $1,240.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.16 / $827.82 / $1,577.62
| Professional | | $522.16 | $827.82 | $1,577.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $4,628.00 / $7,350.00
| Facility | | $2,654.00 | $4,628.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.79 / $782.64 / $1,134.94
| Professional | | $530.79 | $782.64 | $1,134.94 |