- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,698.24 / $1,698.24
| Facility | | $1,071.52 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $263.03 / $309.03
| Professional | | $245.47 | $263.03 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $812.83 / $912.01
| Facility | | $758.58 | $812.83 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $1,023.29
| Facility | | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $218.78
| Professional | | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $223.87 / $537.03
| Professional | | $158.49 | $223.87 | $537.03 |