- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $7,244.36 / $10,471.29
| Facility | | $1,949.84 | $7,244.36 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,380.38
| Professional | | $1,096.48 | $1,096.48 | $1,380.38 |
- 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
- $8,317.64 / $9,772.37 / $21,877.62
| Facility | | $8,317.64 | $9,772.37 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,128.61 / $13,803.84
| Facility | | $2,884.03 | $5,128.61 | $13,803.84 |