- 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
- $293.74 / $458.76 / $743.34
| Professional | | $293.74 | $458.76 | $743.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.48 / $489.05 / $853.14
| Professional | | $323.48 | $489.05 | $853.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.97 / $614.38 / $1,014.71
| Professional | | $453.97 | $614.38 | $1,014.71 |
- 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
- $425.88 / $618.92 / $1,081.18
| Professional | | $425.88 | $618.92 | $1,081.18 |