- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,454.71 / $3,311.31
| Facility | | $1,071.52 | $2,454.71 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,818.38 / $3,890.45
| Professional | | $2,187.76 | $2,818.38 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,630.78 / $4,786.30
| Professional | | $1,202.26 | $3,630.78 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,071.52 / $2,570.40
| Facility | | $371.54 | $1,071.52 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,511.89 / $4,677.35
| Professional | | $2,137.96 | $2,511.89 | $4,677.35 |