- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $2,398.83
| Facility | | $1,096.48 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $288.40 / $537.03
| Professional | | $229.09 | $288.40 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $338.84 / $407.38
| Professional | | $239.88 | $338.84 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $346.74 / $1,148.15
| Professional | | $229.09 | $346.74 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,659.59 / $5,248.07
| Facility | | $660.69 | $1,659.59 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $263.03 / $398.11
| Professional | | $186.21 | $263.03 | $398.11 |