- 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
- $398.11 / $537.03 / $1,348.96
| Professional | | $398.11 | $537.03 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $489.78 / $870.96
| Professional | | $436.52 | $489.78 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $676.08 / $977.24
| Professional | | $512.86 | $676.08 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,570.88 / $7,585.78
| Facility | | $2,570.40 | $4,570.88 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $575.44 / $1,047.13
| Professional | | $407.38 | $575.44 | $1,047.13 |