- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,737.80 / $3,981.07
| Facility | | $794.33 | $1,737.80 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $223.87 / $602.56
| Professional | | $128.82 | $223.87 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $177.83 / $323.59
| Professional | | $107.15 | $177.83 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $245.47 / $407.38
| Professional | | $144.54 | $245.47 | $407.38 |
- 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
- $134.90 / $204.17 / $331.13
| Professional | | $134.90 | $204.17 | $331.13 |