- 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
- $428.24 / $595.25 / $605.37
| Professional | | $428.24 | $595.25 | $605.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.74 / $642.04 / $1,056.01
| Professional | | $545.74 | $642.04 | $1,056.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.00 / $743.97 / $1,106.14
| Professional | | $300.00 | $743.97 | $1,106.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,569.00 / $3,447.00 / $5,685.00
| Facility | | $2,569.00 | $3,447.00 | $5,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.82 / $753.79 / $1,106.16
| Professional | | $463.82 | $753.79 | $1,106.16 |