- 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
- $169.82 / $331.13 / $512.86
| Professional | | $169.82 | $331.13 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $245.47 / $389.05
| Professional | | $147.91 | $245.47 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $288.40 / $616.60
| Professional | | $138.04 | $288.40 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,511.89 / $6,025.60
| Facility | | $1,380.38 | $2,511.89 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $263.03 / $501.19
| Professional | | $134.90 | $263.03 | $501.19 |