- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $6,918.31 / $10,964.78
| Facility | | $4,466.84 | $6,918.31 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $478.63 / $691.83
| Professional | | $346.74 | $478.63 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $295.12 / $977.24
| Professional | | $269.15 | $295.12 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $776.25 / $1,479.11
| Professional | | $489.78 | $776.25 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,884.03 / $7,762.47
| Facility | | $1,412.54 | $2,884.03 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $588.84 / $1,445.44
| Professional | | $346.74 | $588.84 | $1,445.44 |