- 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
- $316.23 / $398.11 / $891.25
| Professional | | $316.23 | $398.11 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $380.19 / $588.84
| Professional | | $281.84 | $380.19 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $407.38 / $707.95
| Professional | | $120.23 | $407.38 | $707.95 |
- 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
- $269.15 / $426.58 / $741.31
| Professional | | $269.15 | $426.58 | $741.31 |