- 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
- $450.49 / $554.27 / $826.85
| Professional | | $450.49 | $554.27 | $826.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.30 / $637.09 / $1,043.44
| Professional | | $460.30 | $637.09 | $1,043.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.16 / $755.22 / $1,021.61
| Professional | | $583.16 | $755.22 | $1,021.61 |
- 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
- $400.42 / $627.76 / $1,094.13
| Professional | | $400.42 | $627.76 | $1,094.13 |