- 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
- $186.21 / $309.03 / $562.34
| Professional | | $186.21 | $309.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $363.08 / $512.86
| Professional | | $208.93 | $363.08 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $676.08
| Facility | | $467.74 | $467.74 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $426.58 / $758.58
| Professional | | $223.87 | $426.58 | $758.58 |
- 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
- $186.21 / $309.03 / $588.84
| Professional | | $186.21 | $309.03 | $588.84 |