- 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
- $339.72 / $535.69 / $829.88
| Professional | | $339.72 | $535.69 | $829.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.83 / $526.15 / $975.05
| Professional | | $357.83 | $526.15 | $975.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.50 / $730.97 / $1,116.33
| Professional | | $500.50 | $730.97 | $1,116.33 |
- 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
- $457.15 / $778.21 / $1,204.25
| Professional | | $457.15 | $778.21 | $1,204.25 |