- 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
- $131.83 / $204.17 / $338.84
| Professional | | $131.83 | $204.17 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $154.88 / $234.42
| Professional | | $117.49 | $154.88 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $190.55 / $363.08
| Professional | | $107.15 | $190.55 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,073.80 / $6,165.95
| Facility | | $1,819.70 | $4,073.80 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $186.21 / $295.12
| Professional | | $125.89 | $186.21 | $295.12 |