- 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
- $292.66 / $462.53 / $724.44
| Professional | | $292.66 | $462.53 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.48 / $489.54 / $872.98
| Professional | | $330.48 | $489.54 | $872.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.38 / $566.10 / $1,000.18
| Professional | | $456.38 | $566.10 | $1,000.18 |
- 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
- $391.98 / $600.32 / $1,044.93
| Professional | | $391.98 | $600.32 | $1,044.93 |