- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,243.94 / $3,955.04
| Facility | | $2,424.15 | $3,243.94 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.71 / $665.27 / $859.62
| Professional | | $505.71 | $665.27 | $859.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.94 / $879.31 / $1,180.40
| Professional | | $598.94 | $879.31 | $1,180.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $709.97 / $951.56 / $1,721.09
| Professional | | $709.97 | $951.56 | $1,721.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,569.00 / $4,571.00 / $7,350.00
| Facility | | $2,569.00 | $4,571.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.41 / $931.23 / $1,788.11
| Professional | | $588.41 | $931.23 | $1,788.11 |