- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,677.35 / $8,511.38
| Facility | | $3,235.94 | $4,677.35 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $173.78 / $478.63
| Professional | | $112.20 | $173.78 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $151.36 / $194.98
| Professional | | $109.65 | $151.36 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $190.55 / $346.74
| Professional | | $165.96 | $190.55 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,467.37 / $6,760.83
| Facility | | $1,288.25 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $288.40 / $478.63
| Professional | | $141.25 | $288.40 | $478.63 |