- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,754.23 / $3,981.07
| Facility | | $2,089.30 | $2,754.23 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $446.68 / $1,174.90
| Professional | | $354.81 | $446.68 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $467.74 / $758.58
| Professional | | $371.54 | $467.74 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $602.56 / $870.96
| Professional | | $426.58 | $602.56 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,412.54 / $6,456.54
| Facility | | $436.52 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $489.78 / $891.25
| Professional | | $338.84 | $489.78 | $891.25 |