- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,548.82 / $3,981.07
| Facility | | $1,513.56 | $1,548.82 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $199.53 / $407.38
| Professional | | $123.03 | $199.53 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $323.59 / $389.05
| Facility | | $162.18 | $323.59 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $138.04 / $190.55
| Professional | | $114.82 | $138.04 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,412.54 / $6,456.54
| Facility | | $436.52 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $263.03 / $562.34
| Professional | | $162.18 | $263.03 | $562.34 |