- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,467.37 / $3,981.07
| Facility | | $2,398.83 | $3,467.37 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $478.63 / $1,318.26
| Professional | | $398.11 | $478.63 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $457.09 / $758.58
| Professional | | $389.05 | $457.09 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $724.44 / $933.25
| Professional | | $512.86 | $724.44 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $7,244.36 / $13,182.57
| Facility | | $3,235.94 | $7,244.36 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $575.44 / $1,047.13
| Professional | | $389.05 | $575.44 | $1,047.13 |