- 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
- $131.83 / $208.93 / $416.87
| Professional | | $131.83 | $208.93 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $218.78 / $363.08
| Professional | | $138.04 | $218.78 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $588.84
| Facility | | $275.42 | $275.42 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $281.84 / $501.19
| Professional | | $151.36 | $281.84 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,398.83 / $6,165.95
| Facility | | $794.33 | $2,398.83 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $213.80 / $380.19
| Professional | | $131.83 | $213.80 | $380.19 |