- 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
- $573.55 / $772.66 / $961.23
| Professional | | $573.55 | $772.66 | $961.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.26 / $757.45 / $1,280.05
| Professional | | $547.26 | $757.45 | $1,280.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $789.01 / $1,029.19 / $1,304.74
| Professional | | $789.01 | $1,029.19 | $1,304.74 |
- 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
- $552.64 / $904.40 / $1,394.24
| Professional | | $552.64 | $904.40 | $1,394.24 |