- 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
- $72.44 / $204.17 / $512.86
| Professional | | $72.44 | $204.17 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $208.93 / $389.05
| Professional | | $75.86 | $208.93 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $676.08
| Facility | | $407.38 | $407.38 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $218.78 / $602.56
| Professional | | $75.86 | $218.78 | $602.56 |
- 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
- $69.18 / $186.21 / $426.58
| Professional | | $69.18 | $186.21 | $426.58 |