- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $2,398.83
| Facility | | $1,096.48 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $331.13 / $812.83
| Professional | | $263.03 | $331.13 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $338.84 / $398.11
| Professional | | $234.42 | $338.84 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $407.38 / $489.78
| Professional | | $208.93 | $407.38 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,659.59 / $5,248.07
| Facility | | $660.69 | $1,659.59 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $302.00 / $446.68
| Professional | | $208.93 | $302.00 | $446.68 |