- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,445.44 / $1,862.09
| Facility | | $575.44 | $1,445.44 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $56.23 / $85.11
| Professional | | $41.69 | $56.23 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $616.60 / $831.76
| Facility | | $524.81 | $616.60 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,148.15 / $2,511.89
| Facility | | $407.38 | $1,148.15 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $48.98 / $75.86
| Professional | | $34.67 | $48.98 | $75.86 |