- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,943.21 / $2,234.69 / $3,886.42
| Facility | | $1,943.21 | $2,234.69 | $3,886.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,515.70 / $1,651.73 / $1,884.91
| Professional | | $1,515.70 | $1,651.73 | $1,884.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.67 / $69.98 / $94.15
| Facility | | $57.67 | $69.98 | $94.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.09 / $721.53 / $1,107.61
| Professional | | $597.09 | $721.53 | $1,107.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,528.34 / $1,642.02 / $6,094.67
| Facility | | $1,528.34 | $1,642.02 | $6,094.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.15 / $816.15 / $1,165.93
| Professional | | $816.15 | $816.15 | $1,165.93 |