- 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
- $28.18 / $112.20 / $446.68
| Professional | | $28.18 | $112.20 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $79.43 / $190.55
| Professional | | $27.54 | $79.43 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $117.49 / $263.03
| Professional | | $36.31 | $117.49 | $263.03 |
- 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
- $30.90 / $102.33 / $245.47
| Professional | | $30.90 | $102.33 | $245.47 |