- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,270.60 / $1,615.21 / $4,501.56
| Facility | | $1,270.60 | $1,615.21 | $4,501.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.37 / $239.84 / $639.44
| Professional | | $180.37 | $239.84 | $639.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.09 / $232.43 / $257.27
| Professional | | $225.09 | $232.43 | $257.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,034.56 / $1,034.56 / $1,034.56
| Facility | | $1,034.56 | $1,034.56 | $1,034.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.05 / $309.11 / $649.42
| Professional | | $203.05 | $309.11 | $649.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.51 / $370.71 / $619.51
| Professional | | $276.51 | $370.71 | $619.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.64 / $293.45 / $510.55
| Professional | | $199.64 | $293.45 | $510.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.17 / $330.48 / $407.52
| Professional | | $216.17 | $330.48 | $407.52 |