- 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 / $131.83 / $338.84
| Professional | | $89.13 | $131.83 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $104.71 / $158.49
| Professional | | $79.43 | $104.71 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $131.83 / $213.80
| Professional | | $72.44 | $131.83 | $213.80 |
- 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
- $85.11 / $141.25 / $186.21
| Professional | | $85.11 | $141.25 | $186.21 |