- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.49 / $1,424.49 / $6,907.00
| Facility | | $1,424.49 | $1,424.49 | $6,907.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.01 / $525.30 / $568.33
| Professional | | $486.01 | $525.30 | $568.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.57 / $532.42 / $1,038.25
| Professional | | $452.57 | $532.42 | $1,038.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $2,200.00 / $2,200.00
| Facility | | $2,200.00 | $2,200.00 | $2,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.83 / $390.21 / $1,055.02
| Professional | | $234.83 | $390.21 | $1,055.02 |