- 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
- $186.21 / $257.04 / $616.60
| Professional | | $186.21 | $257.04 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $223.87 / $416.87
| Professional | | $194.98 | $223.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $354.81 / $457.09
| Professional | | $234.42 | $354.81 | $457.09 |
- 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
- $194.98 / $288.40 / $478.63
| Professional | | $194.98 | $288.40 | $478.63 |