- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.15 / $3,243.94 / $3,955.04
| Facility | | $2,424.15 | $3,243.94 | $3,955.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.36 / $576.85 / $811.19
| Professional | | $406.36 | $576.85 | $811.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.32 / $776.15 / $1,201.31
| Professional | | $540.32 | $776.15 | $1,201.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.77 / $848.60 / $1,270.82
| Professional | | $361.77 | $848.60 | $1,270.82 |
- 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
- $434.82 / $764.38 / $1,339.70
| Professional | | $434.82 | $764.38 | $1,339.70 |