- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $3,706.14 / $6,853.30
| Facility | | $2,090.73 | $3,706.14 | $6,853.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.98 / $542.97 / $713.60
| Professional | | $351.98 | $542.97 | $713.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.08 / $575.59 / $918.70
| Professional | | $364.08 | $575.59 | $918.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.45 / $698.21 / $1,368.53
| Professional | | $437.45 | $698.21 | $1,368.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $2,445.00 / $5,977.00
| Facility | | $1,388.00 | $2,445.00 | $5,977.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.38 / $820.74 / $1,340.36
| Professional | | $558.38 | $820.74 | $1,340.36 |