- 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
- $52.48 / $141.25 / $389.05
| Professional | | $52.48 | $141.25 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $91.20 / $190.55
| Professional | | $43.65 | $91.20 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $151.36 / $323.59
| Professional | | $61.66 | $151.36 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,454.71 / $6,025.60
| Facility | | $1,380.38 | $2,454.71 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $117.49 / $281.84
| Professional | | $56.23 | $117.49 | $281.84 |