- 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
- $535.77 / $735.36 / $867.79
| Professional | | $535.77 | $735.36 | $867.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.46 / $705.13 / $1,115.33
| Professional | | $509.46 | $705.13 | $1,115.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.51 / $905.62 / $1,202.35
| Professional | | $734.51 | $905.62 | $1,202.35 |
- 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
- $504.63 / $822.22 / $1,265.21
| Professional | | $504.63 | $822.22 | $1,265.21 |