- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,342.03 / $1,826.94 / $6,659.26
| Facility | | $1,342.03 | $1,826.94 | $6,659.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.64 / $1,506.62 / $1,645.89
| Professional | | $759.64 | $1,506.62 | $1,645.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.91 / $687.14 / $860.41
| Professional | | $597.91 | $687.14 | $860.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,266.07 / $1,266.07 / $1,266.07
| Facility | | $1,266.07 | $1,266.07 | $1,266.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.95 / $6,635.03 / $7,132.51
| Facility | | $822.95 | $6,635.03 | $7,132.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.75 / $759.64 / $1,645.89
| Professional | | $531.75 | $759.64 | $1,645.89 |