- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,137.96 / $7,762.47
| Facility | | $1,047.13 | $2,137.96 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $204.17 / $338.84
| Professional | | $151.36 | $204.17 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $85.11
| Professional | | $60.26 | $60.26 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $346.74 / $645.65
| Facility | | $114.82 | $346.74 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $8,912.51 / $16,982.44
| Facility | | $891.25 | $8,912.51 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $316.23 / $467.74
| Professional | | $251.19 | $316.23 | $467.74 |