- 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
- $398.11 / $489.78 / $1,047.13
| Professional | | $398.11 | $489.78 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $416.87 / $676.08
| Professional | | $354.81 | $416.87 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $562.34 / $912.01
| Professional | | $371.54 | $562.34 | $912.01 |
- 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
- $309.03 / $446.68 / $645.65
| Professional | | $309.03 | $446.68 | $645.65 |