- 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
- $436.52 / $537.03 / $1,230.27
| Professional | | $436.52 | $537.03 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $478.63 / $776.25
| Professional | | $363.08 | $478.63 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $562.34 / $954.99
| Professional | | $120.23 | $562.34 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,677.35 / $7,585.78
| Facility | | $2,570.40 | $4,677.35 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $575.44 / $954.99
| Professional | | $389.05 | $575.44 | $954.99 |