- 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
- $72.44 / $128.82 / $229.09
| Professional | | $72.44 | $128.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $125.89 / $199.53
| Professional | | $66.07 | $125.89 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $151.36 / $295.12
| Professional | | $85.11 | $151.36 | $295.12 |
- 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
- $75.86 / $138.04 / $263.03
| Professional | | $75.86 | $138.04 | $263.03 |