- 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
- $208.93 / $323.59 / $588.84
| Professional | | $208.93 | $323.59 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $354.81 / $562.34
| Professional | | $223.87 | $354.81 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $676.08
| Facility | | $416.87 | $416.87 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $446.68 / $776.25
| Professional | | $251.19 | $446.68 | $776.25 |
- 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
- $213.80 / $338.84 / $602.56
| Professional | | $213.80 | $338.84 | $602.56 |