- 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 / $85.11 / $169.82
| Professional | | $52.48 | $85.11 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $81.28 / $123.03
| Professional | | $48.98 | $81.28 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $112.20 / $169.82
| Professional | | $63.10 | $112.20 | $169.82 |
- 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
- $56.23 / $91.20 / $141.25
| Professional | | $56.23 | $91.20 | $141.25 |