- 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
- $141.25 / $245.47 / $501.19
| Professional | | $141.25 | $245.47 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $263.03 / $426.58
| Professional | | $147.91 | $263.03 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $446.68
| Facility | | $338.84 | $338.84 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $309.03 / $575.44
| Professional | | $173.78 | $309.03 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,398.83 / $5,495.41
| Facility | | $794.33 | $2,398.83 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $234.42 / $436.52
| Professional | | $144.54 | $234.42 | $436.52 |