- 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
- $257.04 / $323.59 / $870.96
| Professional | | $257.04 | $323.59 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $323.59 / $524.81
| Professional | | $263.03 | $323.59 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $426.58 / $630.96
| Professional | | $295.12 | $426.58 | $630.96 |
- 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
- $239.88 / $363.08 / $660.69
| Professional | | $239.88 | $363.08 | $660.69 |