- 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
- $38.02 / $56.23 / $151.36
| Professional | | $38.02 | $56.23 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $53.70 / $89.13
| Professional | | $39.81 | $53.70 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $79.43 / $117.49
| Professional | | $43.65 | $79.43 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,412.54 / $6,456.54
| Facility | | $436.52 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $70.79 / $114.82
| Professional | | $50.12 | $70.79 | $114.82 |