- 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
- $89.13 / $234.42 / $524.81
| Professional | | $89.13 | $234.42 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $245.47 / $467.74
| Professional | | $95.50 | $245.47 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $2,570.40 / $2,570.40
| Facility | | $446.68 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $281.84 / $724.44
| Professional | | $117.49 | $281.84 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $3,548.13 / $7,413.10
| Facility | | $831.76 | $3,548.13 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $234.42 / $512.86
| Professional | | $95.50 | $234.42 | $512.86 |