- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.22 / $2,090.73 / $3,955.04
| Facility | | $972.22 | $2,090.73 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.43 / $517.86 / $851.92
| Professional | | $352.43 | $517.86 | $851.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.30 / $579.58 / $1,052.06
| Professional | | $400.30 | $579.58 | $1,052.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.51 / $682.23 / $1,184.69
| Professional | | $533.51 | $682.23 | $1,184.69 |
- 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
- $471.04 / $821.18 / $1,241.01
| Professional | | $471.04 | $821.18 | $1,241.01 |