- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $6,025.60 / $14,125.38
| Facility | | $2,754.23 | $6,025.60 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $213.80 / $588.84
| Professional | | $151.36 | $213.80 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $208.93 / $295.12
| Professional | | $190.55 | $208.93 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $467.74 / $870.96
| Professional | | $346.74 | $467.74 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,884.03 / $7,762.47
| Facility | | $1,412.54 | $2,884.03 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $363.08 / $954.99
| Professional | | $169.82 | $363.08 | $954.99 |