- 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
- $165.96 / $234.42 / $588.84
| Professional | | $165.96 | $234.42 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $181.97 / $288.40
| Professional | | $138.04 | $181.97 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $204.17 / $371.54
| Professional | | $134.90 | $204.17 | $371.54 |
- 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
- $131.83 / $208.93 / $316.23
| Professional | | $131.83 | $208.93 | $316.23 |