- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $4,835.71 / $8,680.41
| Facility | | $2,424.15 | $4,835.71 | $8,680.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.08 / $575.47 / $927.81
| Professional | | $389.08 | $575.47 | $927.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.57 / $608.52 / $1,147.56
| Professional | | $429.57 | $608.52 | $1,147.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.43 / $744.15 / $1,266.79
| Professional | | $426.43 | $744.15 | $1,266.79 |
- 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
- $443.20 / $883.32 / $1,349.73
| Professional | | $443.20 | $883.32 | $1,349.73 |