- 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
- $117.49 / $281.84 / $436.52
| Professional | | $117.49 | $281.84 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $199.53 / $331.13
| Professional | | $104.71 | $199.53 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $239.88 / $537.03
| Professional | | $95.50 | $239.88 | $537.03 |
- 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
- $83.18 / $199.53 / $416.87
| Professional | | $83.18 | $199.53 | $416.87 |