- 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
- $351.39 / $389.30 / $585.21
| Professional | | $351.39 | $389.30 | $585.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.94 / $621.41 / $660.53
| Professional | | $416.94 | $621.41 | $660.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.37 / $508.66 / $1,061.28
| Professional | | $292.37 | $508.66 | $1,061.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,654.00 / $4,628.00 / $7,350.00
| Facility | | $2,654.00 | $4,628.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.48 / $524.02 / $786.67
| Professional | | $349.48 | $524.02 | $786.67 |