- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,630.27 / $2,630.27
| Facility | | $1,071.52 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $97.72 / $275.42
| Professional | | $52.48 | $97.72 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $676.08
| Facility | | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $144.54 / $169.82
| Professional | | $144.54 | $144.54 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $107.15 / $208.93
| Professional | | $48.98 | $107.15 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $109.65 / $257.04
| Professional | | $69.18 | $109.65 | $257.04 |