- 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 / $131.83 / $288.40
| Professional | | $52.48 | $131.83 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $75.86 / $138.04
| Professional | | $41.69 | $75.86 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $114.82 / $234.42
| Professional | | $57.54 | $114.82 | $234.42 |
- 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
- $52.48 / $93.33 / $190.55
| Professional | | $52.48 | $93.33 | $190.55 |