- 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
- $331.83 / $476.64 / $782.63
| Professional | | $331.83 | $476.64 | $782.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.55 / $524.12 / $985.61
| Professional | | $370.55 | $524.12 | $985.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.67 / $639.14 / $1,082.56
| Professional | | $486.67 | $639.14 | $1,082.56 |
- 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
- $432.32 / $752.75 / $1,165.21
| Professional | | $432.32 | $752.75 | $1,165.21 |