- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,715.35 / $3,981.07
| Facility | | $3,467.37 | $3,715.35 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $354.81 / $912.01
| Professional | | $239.88 | $354.81 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $309.03 / $549.54
| Professional | | $234.42 | $309.03 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $501.19 / $660.69
| Professional | | $181.97 | $501.19 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,128.61 / $12,022.64
| Facility | | $2,818.38 | $5,128.61 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $416.87 / $676.08
| Professional | | $281.84 | $416.87 | $676.08 |