- 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 / $251.19 / $489.78
| Professional | | $117.49 | $251.19 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $194.98 / $309.03
| Professional | | $102.33 | $194.98 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $229.09 / $512.86
| Professional | | $97.72 | $229.09 | $512.86 |
- 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 / $190.55 / $380.19
| Professional | | $83.18 | $190.55 | $380.19 |