- 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
- $158.49 / $288.40 / $537.03
| Professional | | $158.49 | $288.40 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $281.84 / $501.19
| Professional | | $154.88 | $281.84 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $354.81 / $575.44
| Professional | | $204.17 | $354.81 | $575.44 |
- 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
- $154.88 / $281.84 / $575.44
| Professional | | $154.88 | $281.84 | $575.44 |