- 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
- $87.10 / $147.91 / $177.83
| Professional | | $87.10 | $147.91 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $123.03 / $141.25
| Facility | | $102.33 | $123.03 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,412.54 / $6,456.54
| Facility | | $316.23 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $162.18 / $245.47
| Professional | | $138.04 | $162.18 | $245.47 |