- 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
- $325.49 / $433.41 / $592.36
| Professional | | $325.49 | $433.41 | $592.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.37 / $606.40 / $713.41
| Professional | | $397.37 | $606.40 | $713.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.00 / $593.00 / $2,591.44
| Facility | | $593.00 | $593.00 | $2,591.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.05 / $656.92 / $1,089.39
| Professional | | $416.05 | $656.92 | $1,089.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.00 / $2,384.00 / $5,510.00
| Facility | | $1,395.00 | $2,384.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.31 / $629.34 / $1,097.51
| Professional | | $428.31 | $629.34 | $1,097.51 |