- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $616.60 / $3,981.07
| Facility | | $562.34 | $616.60 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $229.09 / $537.03
| Professional | | $95.50 | $229.09 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $158.49 / $263.03
| Professional | | $83.18 | $158.49 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $257.04 / $446.68
| Professional | | $131.83 | $257.04 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,454.71 / $6,025.60
| Facility | | $1,380.38 | $2,454.71 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $173.78 / $354.81
| Professional | | $91.20 | $173.78 | $354.81 |