- 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
- $138.04 / $346.74 / $776.25
| Professional | | $138.04 | $346.74 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $295.12 / $588.84
| Professional | | $131.83 | $295.12 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $363.08 / $794.33
| Professional | | $173.78 | $363.08 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,073.80 / $6,165.95
| Facility | | $1,819.70 | $4,073.80 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $323.59 / $724.44
| Professional | | $141.25 | $323.59 | $724.44 |