- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,715.35 / $3,981.07
| Facility | | $3,019.95 | $3,715.35 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $501.19 / $1,348.96
| Professional | | $436.52 | $501.19 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $457.09 / $758.58
| Professional | | $338.84 | $457.09 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $549.54 / $912.01
| Professional | | $181.97 | $549.54 | $912.01 |
- 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
- $389.05 / $549.54 / $933.25
| Professional | | $389.05 | $549.54 | $933.25 |