- 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
- $79.43 / $93.33 / $199.53
| Professional | | $79.43 | $93.33 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $75.86 / $144.54
| Professional | | $56.23 | $75.86 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $91.20 / $158.49
| Professional | | $56.23 | $91.20 | $158.49 |
- 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
- $47.86 / $85.11 / $138.04
| Professional | | $47.86 | $85.11 | $138.04 |