- 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
- $25.12 / $53.70 / $134.90
| Professional | | $25.12 | $53.70 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $51.29 / $97.72
| Professional | | $21.88 | $51.29 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $66.07 / $173.78
| Professional | | $30.20 | $66.07 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,412.54 / $6,456.54
| Facility | | $416.87 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $61.66 / $125.89
| Professional | | $28.18 | $61.66 | $125.89 |