- 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
- $257.04 / $316.23 / $851.14
| Professional | | $257.04 | $316.23 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $281.84 / $467.74
| Professional | | $208.93 | $281.84 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $354.81 / $562.34
| Professional | | $89.13 | $354.81 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,073.80 / $6,165.95
| Facility | | $1,819.70 | $4,073.80 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $338.84 / $575.44
| Professional | | $239.88 | $338.84 | $575.44 |