- 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
- $502.72 / $585.70 / $1,222.27
| Professional | | $502.72 | $585.70 | $1,222.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.47 / $626.44 / $980.79
| Professional | | $532.47 | $626.44 | $980.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.74 / $699.42 / $1,117.89
| Professional | | $410.74 | $699.42 | $1,117.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.88 / $2,445.00 / $4,602.00
| Facility | | $1,150.88 | $2,445.00 | $4,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.29 / $834.67 / $1,044.68
| Professional | | $536.29 | $834.67 | $1,044.68 |