- 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
- $20.89 / $36.31 / $190.55
| Professional | | $20.89 | $36.31 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $44.67 / $72.44
| Professional | | $28.18 | $44.67 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $89.13 / $257.04
| Professional | | $46.77 | $89.13 | $257.04 |
- 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
- $20.42 / $31.62 / $69.18
| Professional | | $20.42 | $31.62 | $69.18 |