- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,235.94 / $3,981.07
| Facility | | $1,288.25 | $3,235.94 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $630.96 / $1,230.27
| Professional | | $354.81 | $630.96 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $363.08 / $616.60
| Professional | | $275.42 | $363.08 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $467.74 / $758.58
| Professional | | $151.36 | $467.74 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,677.35 / $7,585.78
| Facility | | $2,570.40 | $4,677.35 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $489.78 / $691.83
| Professional | | $323.59 | $489.78 | $691.83 |