- 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
- $33.88 / $57.54 / $141.25
| Professional | | $33.88 | $57.54 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $45.71 / $83.18
| Professional | | $38.90 | $45.71 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $75.86 / $109.65
| Professional | | $38.90 | $75.86 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,412.54 / $6,456.54
| Facility | | $316.23 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $67.61 / $107.15
| Professional | | $51.29 | $67.61 | $107.15 |