- 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
- $303.33 / $500.30 / $773.16
| Professional | | $303.33 | $500.30 | $773.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.60 / $569.53 / $897.05
| Professional | | $366.60 | $569.53 | $897.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.00 / $596.34 / $1,045.29
| Professional | | $488.00 | $596.34 | $1,045.29 |
- 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
- $416.46 / $724.56 / $1,122.38
| Professional | | $416.46 | $724.56 | $1,122.38 |