- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $2,778.87 / $3,955.04
| Facility | | $2,090.73 | $2,778.87 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.45 / $652.77 / $762.70
| Professional | | $459.45 | $652.77 | $762.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.09 / $603.59 / $1,020.51
| Professional | | $436.09 | $603.59 | $1,020.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.73 / $824.23 / $1,044.09
| Professional | | $628.73 | $824.23 | $1,044.09 |
- 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
- $450.24 / $723.73 / $1,116.15
| Professional | | $450.24 | $723.73 | $1,116.15 |