- 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
- $567.30 / $669.36 / $827.39
| Professional | | $567.30 | $669.36 | $827.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.03 / $782.05 / $1,038.41
| Professional | | $565.03 | $782.05 | $1,038.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $814.64 / $968.78 / $1,300.36
| Professional | | $814.64 | $968.78 | $1,300.36 |
- 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
- $545.77 / $810.19 / $1,344.14
| Professional | | $545.77 | $810.19 | $1,344.14 |