- 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
- $85.11 / $117.49 / $309.03
| Professional | | $85.11 | $117.49 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $102.33 / $165.96
| Professional | | $77.62 | $102.33 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $154.88 / $257.04
| Professional | | $114.82 | $154.88 | $257.04 |
- 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
- $93.33 / $158.49 / $234.42
| Professional | | $93.33 | $158.49 | $234.42 |