- 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
- $423.77 / $594.54 / $845.62
| Professional | | $423.77 | $594.54 | $845.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.58 / $876.83 / $1,133.32
| Professional | | $595.58 | $876.83 | $1,133.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.18 / $977.65 / $1,446.59
| Professional | | $385.18 | $977.65 | $1,446.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,569.00 / $3,447.00 / $7,350.00
| Facility | | $2,569.00 | $3,447.00 | $7,350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $639.09 / $910.95 / $1,543.01
| Professional | | $639.09 | $910.95 | $1,543.01 |