- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $5,011.87 / $12,589.25
| Facility | | $1,071.52 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,174.90 / $2,290.87
| Facility | | $891.25 | $1,174.90 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $676.08 / $3,019.95
| Facility | | $389.05 | $676.08 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,000.00 / $1,380.38
| Professional | | $724.44 | $1,000.00 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,162.28 / $8,128.31
| Facility | | $2,570.40 | $3,162.28 | $8,128.31 |