- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,467.37 / $4,570.88
| Facility | | $2,951.21 | $3,467.37 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $2,818.38
| Professional | | $562.34 | $562.34 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $44.67 / $60.26
| Professional | | $30.20 | $44.67 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $776.25 / $1,737.80
| Facility | | $660.69 | $776.25 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,466.84 / $5,128.61
| Facility | | $1,071.52 | $4,466.84 | $5,128.61 |