- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,235.94 / $7,413.10
| Facility | | $1,548.82 | $3,235.94 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,511.89 / $4,897.79
| Professional | | $2,089.30 | $2,511.89 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $263.03 / $316.23
| Professional | | $223.87 | $263.03 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,011.87 / $15,135.61
| Facility | | $2,398.83 | $5,011.87 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,630.78 / $8,912.51
| Facility | | $1,819.70 | $3,630.78 | $8,912.51 |