- 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
- $458.65 / $667.58 / $883.35
| Professional | | $458.65 | $667.58 | $883.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $612.16 / $765.06 / $1,139.38
| Professional | | $612.16 | $765.06 | $1,139.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.80 / $937.57 / $1,263.07
| Professional | | $530.80 | $937.57 | $1,263.07 |
- 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
- $431.66 / $900.13 / $1,398.13
| Professional | | $431.66 | $900.13 | $1,398.13 |