- 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
- $81.28 / $199.53 / $524.81
| Professional | | $81.28 | $199.53 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $562.34 / $1,737.80
| Facility | | $354.81 | $562.34 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $165.96 / $263.03
| Professional | | $75.86 | $165.96 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $186.21 / $416.87
| Professional | | $89.13 | $186.21 | $416.87 |
- 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
- $93.33 / $204.17 / $346.74
| Professional | | $93.33 | $204.17 | $346.74 |