- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,090.73 / $2,778.87 / $3,955.04
| Facility | | $2,090.73 | $2,778.87 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.02 / $530.58 / $859.01
| Professional | | $322.02 | $530.58 | $859.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.06 / $575.40 / $973.86
| Professional | | $371.06 | $575.40 | $973.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.66 / $631.50 / $1,176.54
| Professional | | $456.66 | $631.50 | $1,176.54 |
- 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
- $424.60 / $839.25 / $1,267.60
| Professional | | $424.60 | $839.25 | $1,267.60 |