- 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
- $151.36 / $269.15 / $501.19
| Professional | | $151.36 | $269.15 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $309.03 / $446.68
| Professional | | $165.96 | $309.03 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $2,570.40 / $2,570.40
| Facility | | $588.84 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $338.84 / $676.08
| Professional | | $190.55 | $338.84 | $676.08 |
- 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
- $151.36 / $257.04 / $478.63
| Professional | | $151.36 | $257.04 | $478.63 |