- 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
- $154.88 / $309.03 / $398.11
| Professional | | $154.88 | $309.03 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $218.78 / $295.12
| Professional | | $147.91 | $218.78 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $295.12 / $436.52
| Professional | | $208.93 | $295.12 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,548.13 / $7,244.36
| Facility | | $1,513.56 | $3,548.13 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $204.17 / $389.05
| Professional | | $123.03 | $204.17 | $389.05 |