- 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
- $154.88 / $181.97 / $512.86
| Professional | | $154.88 | $181.97 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $186.21 / $295.12
| Professional | | $165.96 | $186.21 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $288.40 / $363.08
| Professional | | $194.98 | $288.40 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,412.54 / $6,456.54
| Facility | | $436.52 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $223.87 / $389.05
| Professional | | $162.18 | $223.87 | $389.05 |