- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,754.40 / $13,489.63
| Facility | | $3,019.95 | $5,754.40 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,412.54 / $3,467.37
| Facility | | $1,023.29 | $1,412.54 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $478.63 / $549.54
| Professional | | $426.58 | $478.63 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,137.96 / $6,456.54
| Facility | | $724.44 | $2,137.96 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $489.78 / $776.25
| Professional | | $346.74 | $489.78 | $776.25 |