- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,897.79 / $11,748.98
| Facility | | $2,089.30 | $4,897.79 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $676.08 / $1,621.81
| Facility | | $489.78 | $676.08 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $229.09 / $257.04
| Professional | | $204.17 | $229.09 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $165.96 / $239.88
| Facility | | $120.23 | $165.96 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $181.97 / $295.12
| Professional | | $138.04 | $181.97 | $295.12 |