- 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
- $151.36 / $245.47 / $467.74
| Professional | | $151.36 | $245.47 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $229.09 / $416.87
| Professional | | $144.54 | $229.09 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $295.12 / $524.81
| Professional | | $194.98 | $295.12 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,511.89 / $6,025.60
| Facility | | $1,380.38 | $2,511.89 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $257.04 / $478.63
| Professional | | $154.88 | $257.04 | $478.63 |