- 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
- $281.84 / $426.58 / $870.96
| Professional | | $281.84 | $426.58 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $354.81 / $630.96
| Professional | | $263.03 | $354.81 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $467.74 / $891.25
| Professional | | $151.36 | $467.74 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,677.35 / $7,585.78
| Facility | | $2,570.40 | $4,677.35 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $457.09 / $812.83
| Professional | | $288.40 | $457.09 | $812.83 |