- 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
- $466.16 / $731.42 / $780.54
| Professional | | $466.16 | $731.42 | $780.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.68 / $694.37 / $1,083.14
| Professional | | $501.68 | $694.37 | $1,083.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $723.30 / $861.61 / $1,172.33
| Professional | | $723.30 | $861.61 | $1,172.33 |
- 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
- $506.90 / $809.44 / $1,228.70
| Professional | | $506.90 | $809.44 | $1,228.70 |