- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,438.26 / $3,706.14 / $4,026.21
| Facility | | $3,438.26 | $3,706.14 | $4,026.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.66 / $547.24 / $832.09
| Professional | | $536.66 | $547.24 | $832.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.71 / $680.84 / $1,244.01
| Professional | | $578.71 | $680.84 | $1,244.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.00 / $787.72 / $1,121.61
| Professional | | $350.00 | $787.72 | $1,121.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $3,447.00 / $7,350.00
| Facility | | $2,654.00 | $3,447.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.20 / $669.16 / $1,135.09
| Professional | | $547.20 | $669.16 | $1,135.09 |