- 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
- $275.42 / $436.52 / $933.25
| Professional | | $275.42 | $436.52 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $398.11 / $691.83
| Professional | | $354.81 | $398.11 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $537.03 / $758.58
| Professional | | $416.87 | $537.03 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,570.88 / $7,585.78
| Facility | | $2,570.40 | $4,570.88 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $446.68 / $851.14
| Professional | | $309.03 | $446.68 | $851.14 |