- 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
- $213.80 / $275.42 / $537.03
| Professional | | $213.80 | $275.42 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $363.08 / $524.81
| Professional | | $275.42 | $363.08 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $2,570.40 / $2,570.40
| Facility | | $676.08 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $398.11 / $660.69
| Professional | | $229.09 | $398.11 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,398.83 / $5,754.40
| Facility | | $794.33 | $2,398.83 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $323.59 / $588.84
| Professional | | $199.53 | $323.59 | $588.84 |